Tailored, Proactive Quality Monitoring and Communication

ikaSystems offers two HEDIS Certified Software solutions for health plans seeking to streamline HEDIS and other quality reporting capabilities:

• ikaProHEDIS+: gives health plans unprecedented ability to proactively monitor and share quality data with staff, physicians and members, supporting HEDIS and other quality programs with timely and actionable information and easy-to-use tracking tools
• ikaHEDIS: classic HEDIS reporting with a twist — Web-based tools that facilitate periodic communication with physicians throughout the year plus ikaSystems’ expertise in ensuring HEDIS scores will be transparent, credible and as high as possible

ikaProHEDIS+: Meaningful Quality Information, When and How It’s Needed

ikaProHEDIS+ is a flexible, Web-based application that combines analytic and workflow tools to enable proactive quality management. Health plans can analyze their quality status at any time, with easy-to-run ad hoc and customized reports that draw upon real-time or near-real-time data. Caregivers, in turn, gain regular access to current — not retrospective — information, allowing them to take action to improve patient care.

ikaProHEDIS+ helps health plans heighten collaboration between themselves and providers and members in the quality improvement process:

• Providers regularly receive information, such as claims, laboratory results and clinical outcomes, that highlights individual patients who are not receiving required care, allowing them to actively pursue patients for routine preventive screenings, testing and chronic care monitoring.
• Physicians and care managers can track progress toward quality improvement goals, including HEDIS, in real time.
• Providers, care managers and patients can receive notification when a threshold for a clinical measure is exceeded or another gap in care exists through multiple HIPAA-compliant communication channels — a secure Web site, phone, fax and email. Multi-channel communication improves participation and involvement by providers, care managers and members.
• All participants can easily share information, arrange for care (e.g., schedule appointments) and communicate changes in care plans.
• Repeated automated attempts are made to contact physicians and patients, and eventually a fax report is sent to physicians, increasing accountability.
• Standard reports meeting HEDIS and organizational requirements are clear and easy to generate, while ad hoc reporting is intuitive for any user.
• Workflow tools allow physicians to update completed HEDIS records directly in ikaProHEDIS+, reducing the need for chart reviews at year end.

ikaHEDIS: Streamlined, Web-Based HEDIS Reporting

For health plans looking for a more traditional HEDIS reporting offering, ikaHEDIS provides a standard set of certified HEDIS measures for submission to NCQA in a timeframe sensitive to a plan’s HEDIS identification and submission needs for the current reporting year. ikaHEDIS enables year-end reporting to NCQA, along with the ability to check HEDIS standings during the reporting year.

ikaSystems, ikaHEDIS and the health plan form a vital partnership that:

• Ensures that all HEDIS and encounter-related data are captured from all data sources to generate the most accurate results possible from current and prior years’ data
• Validates all relevant data files and data elements in the files throughout the year to ensure resolution of potential data problems before HEDIS reports are generated
• Generates and reviews HEDIS results, identifying abnormal measure results, reviewing the data carefully and, if necessary, rerunning the data
• Drills into the data at the member level to explain why certain results occur and ensure that all possible avenues are explored to achieve the best possible results for the plan
• Enables chart review:
  
  • Uses NCQA specifications to identify measures, members and providers for chart reviews
  • Integrates chart review results into the final HEDIS results
  • Provides an IDSS tool for NCQA submission

In addition, ikaSystems provides complete HEDIS reporting services for organizations looking to outsource these functions.