HEDIS Quality Reporting

Hexplora, a HEDIS certified vendor, offers a Quality Management solution that provides
comprehensive Reporting and Analytics at Population, Provider, and Member level. Our solution
allows a Health Plan to track performance measurement of Quality Measures across Commercial,
Medicare, and Medicaid lines of business including HEDIS, STARs, and state-specific Medicaid
measures.

Hexplora provides robust solution to help overcome challenges associated with HEDIS Reporting.
Hexplora helps payers analyze and address Stars and HEDIS measures with robust predictive
analytics and a scalable processing system. HEXPLORA seamlessly integrates data; categorizes
dashboards and reports based on health plans, overall measure and product lines and establishes a
benchmark across – providers, practices, organizations, etc..

As Hexplora is a HEDIS certified vendor, Health plans can rely on the accuracy of quality measure
rates and care gaps identified by our solution. Health plans can collaboratively and seamlessly
engage Providers in achieving compliance with the quality measures. Hexplora portal offers the
capability for Providers to track and monitor quality measures and care gaps for their assigned
patients directly from the portal or through subscription reports that are automatically emailed to
them at provider selected frequencies. Role-based security ensures that Providers can view and
access only their assigned patients.

Quality measure rates calculated in the first half of the year, based on year-to-date partial data, are
not fully indicative of the underlying quality compliance. Hexplora provides the ability for health
plans to also view compliance rates based on a rolling prior 12-month timeframe.

Hexplora’s quality reporting maximizes the output in following ways:

  • Proactive and continuous monitoring of Quality Measures including HEDIS and Medicare
    STARs
  • Identification and tracking of Quality Gaps across time
  • Comprehensive Analytics for tracking of cost and utilization trends by measure
  • HEDIS measure tracking, Reporting, and Submission

Proactive and continuous monitoring of Quality Measures including HEDIS and Medicare STARs

Our quality reporting empowers health plans and care providers to seamlessly monitor the HEDIS
score to make proactive interventions to meet the regulatory requirement without fail with the
power of data-driven quality analytics. Measure end-to-end care effectiveness at provider-level
across all the healthcare organizations located at different sites in a centralized platform. All the
provider network can generate insights to be in the know of care gaps to create more engaging
programs while meeting the HEDIS star rating.

Identification and tracking of Quality Gaps across time

Healthcare organizations aspire to offer high-quality care to every patient but continue to fail in
meeting quality compliance measures perhaps because of inadequate quality tools providing a 360-
degree view of patient’ care. Hexplora consolidates clinical and claims records in one location – in all
likelihood – clearing up the ambiguity and motivating care management team to pinpoint reasons
for lacking in HEDIS quality measures.

Comprehensive Analytics for tracking of cost and utilization trends by measure

In-depth analytics enable healthcare authorities to discover underlying trends and possible
interventions which were overlooked in unstructured patients records in a few clicks. Our reporting
solution motivates coordinated teams to create impactful Managed Long-term Care (MLTC)
programs for chronically ill patients. Our customizable solution aims to improve patient engagement
that improves patient compliance which in turn exponentially increase financial outcome.

HEDIS measure tracking, Reporting, and Submission

Health plans can continuously measure the performance of healthcare providers across all the five
domains of HEDIS and critical dimensions of care. Moreover, our reporting solution allows health
plans to compare performance on “apple-to-apple” basis. With comprehensive reporting, get full
transparency into numerators, denominators and exclusions bridging the gap between patients and
providers. Hexplora ensures provider data submission complies with annual updates in
measurement sets and enables to make state-specific submissions.