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As we wrap up the Healthcare Effectiveness Data and Information Set (HEDIS) 2022 season, we want to express our gratitude for your collaboration as a provider and share some exciting news regarding our future endeavors to enhance documentation standardization and improve health record accuracy.

The CCA Quality Program continuously explores new and exciting opportunities to drive improvement. Traditionally, HEDIS measurement has been an annual process administered by the National Committee for Quality Assurance (NCQA) and completed by health plans nationwide.  This is our second year taking a proactive approach by  expanding our year-round process to enhance documentation for various essential health maintenance measures. This ongoing review ensures the most accurate and up-to-date information within the legal health records maintained here at CCA, benefiting our members.  Our goal is to reduce the volume of one-time requests to provider offices – and associated staff burden- by shifting from retrospective to prospective reviewing. This change also enables us to measure performance closer to real-time, allowing for timely intervention and care coordination with our network providers.

The HEDIS medical record data collected this year identified the following measure opportunities:

Regular screenings are essential for maintaining the well-being of our members. Take proactive steps by ordering follow-up screenings to ensure optimal health.

Colorectal Cancer ScreeningBreast Cancer ScreeningBone Density Screening

Continuous monitoring of the health status of members with chronic conditions, such as hypertension and diabetes, is paramount to effectively managing their care. Consequently, it is crucial to ensure that annual monitoring of conditions is conducted and controlled within specific ranges.

Blood Pressure Values <140/90Hemoglobin A1c Values <9Routine Retinal Eye Exams

To mitigate the potential risks faced by our vulnerable populations, particularly older women, we must prioritize comprehensive care to address fall prevention and the management of osteoporosis.

Order a bone density test to evaluate women aged 67-85 in the 6 months following a fall

We encourage you to explore ways to enhance clinical documentation standards within your practice. To support this, CCA maintains documentation reference guides on our Provider Portal.

Our Quality Documentation Reference Guides provide examples of documentation standards that can be easily incorporated into any workflow process:

Prevention and Screening Quality Documentation Reference Guide

Cardiovascular Conditions and Diabetes Quality Documentation Reference Guide

Care Coordination and Access Availability Quality Documentation Reference Guide

Musculoskeletal Conditions Quality Documentation Reference Guide

Behavioral Health Quality Documentation Reference Guide

MassHealth Quality Documentation Reference Guide

We look forward to our continued collaboration in pursuit of delivering exceptional healthcare experiences. Thank you for your ongoing commitment to excellence.

Warm regards,
The Quality Department at Commonwealth Care Alliance