Overview
Transitioning from a medical setting to a new environment after hospitalization is a very vulnerable time for patients, and one that must be monitored closely to ensure successful overall treatment. The National Committee for Quality Assurance (NCQA) has developed the Transitions of Care (TRC) measure as part of their HEDIS® measure set to better track the timely continuity of care following an inpatient discharge.
Moda Health, a health insurance company based in Portland, Oregon, reached out to KDJ consultants for assistance improving rates and star ratings for the Transitions of Care (TRC) measure. As healthcare catalysts on a mission to improve healthcare outcomes through reliable, accurate, and secure medical record review, the expert team at KDJ Consultants worked together to build a plan that would help Moda Health reach their goals.
Solution
KDJ Consultants worked with the client to develop a data entry tool and export system to capture required data elements for appropriate supplemental data HEDIS® reporting. From there, KDJ Consultants received a monthly file from the client to identify members that met inclusion criteria for the Transitions of Care measure based on their discharge from an inpatient facility in the prior month. Through remote EMR access or fax/mail, KDJ Consultants was able to request medical records, abstract those records using the NCQA (National Committee for Quality Assurance) HEDIS® TRC technical specifications, and input them into the data entry tool. Monthly reports were provided to the client, and support was provided to complete the required primary source verification audit.
Results
As a direct result of this work, the client saw improved rates for the TRC measure and was able to reduce the medical record review burden during medical record review season by utilizing the supplemental data reporting. Both the client and KDJ Consultants were able to review records in an extended time frame, which allowed for additional follow up, internal discussion, and questions to the auditor and NCQA based on findings.
“Moda Health recommends KDJ Consultants for anyone looking for a partner to support their HEDIS® TRC objectives. Through their expertise and dedication, we witnessed a significant increase across all four TRC sub-measures, demonstrating a clear improvement in our data quality. Notably, KDJ’s contributions directly enhanced our ability to locate and retrieve the correct member charts, streamlining our processes. We highly recommend KDJ Consultants to any organization seeking impactful and measurable improvements in their HEDIS® performance.”