Blue Review
A newsletter for contracting institutional and professional providers

November 2018

HEDIS® Measure for Hospital Readmissions

As part of a quality initiative to help assess effectiveness of care and services to our members, Blue Cross and Blue Shield of Illinois (BCBSIL) uses specifications published by the National Committee for Quality Assurance (NCQA) for Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is one of the most widely used and nationally accepted effectiveness of care measurements available.

Hospital readmissions are costly for health care facilities, managed care organizations, and for BCBSIL members. Understanding where the gap in care occurs is often the first step to reducing readmission rates.

Plan all cause readmissions is a HEDIS measure that measures the number of acute inpatient stays for members 18 years and older, during the measurement year and 31 days prior to the last day of the measurement year. BCBSIL collects data from inpatient claims to generate reports that providers may want to review and follow up with members based on the information.

We appreciate the care and services you provide to help improve the health and well-being of our members. Below are a few tips and strategies you may want to apply with your patients.

  • Utilize a discharge coordinator who can help members with the post-discharge process, such as:
    • Ensure patients have appointments set up within specified time frames
    • Discuss the importance of post-discharge care, using the teach-back method
    • Reconcile medication for any updates
    • Follow up with members by phone, letter or email
  • Refer patients to community resources available in your area
  • Identify and monitor high risk patients, such as members who have two or more chronic diseases or conditions and are more likely to visit the ER
  • Develop a care plan involving everyone on a patient’s care team, including the patient

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.

HEDIS is a registered trademark of NCQA