Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

How to Reduce Obesity Rates, Increase HEDIS Quality Scores

Healthcare payers could see higher HEDIS quality scores by investing in childhood obesity intervention programs.

HEDIS Quality Measures

Source: Thinkstock

By Vera Gruessner

- When attempting to improve provider performance on HEDIS quality scores, healthcare payers may need to pick and choose the quality measures that could be realistically raised. For example, childhood obesity may be one of the most common health conditions that pediatricians see. HEDIS quality measures call for screening Body Mass Index (BMI) and improving weight management among children as well as adults.

How can health insurers assist primary care and pediatric clinics in treating childhood obesity? One study published in JAMA Pediatrics suggests implementing a computerized clinical decision support system for pediatric staff and primary care physicians as well as support behavioral changes among families to reduce higher BMI rates.

The researchers followed 549 children ranging in age from six to twelve years with a BMI in the 95th percentile. The interventions and follow-ups lasted about two years. Both clinical decision support tools and self-guided behavioral changes were incorporated to reduce childhood obesity rates. The study found that both efforts enhanced the quality of care in treating childhood obesity.

Health insurance companies may need to include financial incentives in their payment contracts that would stimulate providers to invest in childhood obesity programs and clinical decision support tools. Such efforts should improve performance on HEDIS quality measures.

A report from the Robert Wood Johnson Foundation outlines some other methods that stakeholders could take to reduce childhood obesity rates and boost HEDIS quality scores. First, payers will need to analyze their population and identify priority groups. Any disparities in terms of obesity and health need to be targeted. Health disparities may include social factors like poverty, access to care, emergency department visits, and the use of preventive care.

“According to the Census Bureau’s 2014 Current Population Survey (CPS), approximately 38 percent of African American children under 18 years of age live below poverty and over 43 percent of children under age 5 live below the poverty line. For Hispanics, approximately 30 percent of children under 18 years of age and 33 percent under age 5 live below the poverty line,” according to the Robert Wood Johnson report.

Next, the report suggests identifying the organization’s aim on what factors to improve for the targeted population. To ensure higher HEDIS quality scores, payers and providers should aim to reduce high BMI scores and encourage making healthier lifestyle choices.

Once the aim of how to improve performance on HEDIS quality measures has been targeted, stakeholders will need to develop an action plan, the Robert Wood Johnson report recommends. Within an action plan, primary drivers must be identified and interventions must be developed to improve provider performance on HEDIS quality measures. Additionally, key staff, partners, and organizations will need to be identified to help drive changes in childhood obesity rates.

The last steps the report suggests for healthcare payers and providers to incorporate are to monitor progress, define quantitative outcomes, and utilize quality improvement processes.

Along with these suggestions, a study published by the Kaiser Permanente Center for Health Research found that 26 or more hours of weight loss intervention contact have a higher chance of decreasing BMI levels in overweight children and adolescents. The researchers analyzed 45 behavior-based interventions and noticed that more contact hours led to better results.

Among obese or overweight children, lifestyle-based weight loss programs with 26 or more contact hours led to consistent reductions in obesity rates. Payers could use this information to financially reward pediatricians who spend at least 26 hours on weight loss intervention with overweight children.

“A fairly large and recent body of literature on lifestyle-based weight loss programs with at least 26 hours of contact consistently demonstrated small average reductions in excess weight compared to usual care or other control groups in children and adolescents who were overweight or had obesity,” the study authors wrote.

“Behavior-based interventions with fewer hours of contact rarely demonstrated benefit, although very limited evidence suggested that briefer interventions may be effective in children who are overweight but do not have obesity. Hours of contact was the only study or intervention characteristic that was clearly related to effect size, with larger effects seen in trials with more contact hours.”

In order to improve provider performance on HEDIS quality measures and reduce childhood obesity rates, health insurance professionals will need to implement the steps outlined above. 


Sign up for our free newsletter:

Our privacy policy

no, thanks