The American Cancer Society's 2023 estimates for cervical cancer in the United States include a possible 13,960 new cases of invasive cervical cancer to be diagnosed—and that 4,310 women will potentially die from cervical cancer. However, the organization notes that these cancers rarely occur in women who have been getting regular tests to screen for cervical cancer before they were 65.
In recognition of January being Cervical Cancer Awareness Month, it is key for plans to encourage eligible members to take preventive action. NCQA’s most recent data for the Cervical Cancer Screening (CCS) HEDIS® measure rate shows a troubling downward trend for those seeking cervical cancer screenings over the past 20 years, and plans should stay vigilant in keeping the number from trending any lower. We will explore how to optimize preventative care efforts related to the CCS measure in this blog post, the first of a yearlong series: Closing the Gap. This blog series will focus on different areas in which plans can support member health and close care gaps to improve HEDIS and Star Ratings, while enhancing member engagement.
Let’s walk through optimizing cervical cancer screening data collection and measurement by looking at how to structure hybrid measure projects in general, focusing on record retrieval and abstraction, and creating a comprehensive chart review plan.
Getting started with hybrid measure projects
The CCS measure is one of a group of HEDIS measures known as hybrid measures. Hybrid measures combine administrative claims data with data abstracted from member records during medical record review. When starting hybrid measure projects, begin with an initial assessment of how you performed last year to develop a strategy with your team for the year ahead. Apply your learnings from last year, tweaking your medical record retrieval logic to make sure you’re going after the most appropriate location for cervical cancer screening medical records to increase your likelihood of properly sourcing that record. At a minimum, before you kick off your project every year you should:
- Use test runs to help ensure you are prepared. Clean up provider and location data, establish workflows, and train nurses. This is the perfect opportunity to identify weak areas and to tidy data for the most accurate representation of where you stand.
- Proactively interact with large provider groups in your area. Discuss methods for success including how to deliver requests, needs for on-site support, methods for optimal communication, and ways to prevent provider burnout. Finally, plans should establish a cadence of reporting and leadership reviews to monitor performance as the season progresses, adjusting efforts as needed.
Sourcing and abstracting records
Another element of hybrid measure projects is the sourcing of records, though it can be a challenge for health plans to source records on their own. Retrieval efforts can be thwarted by time constraints, heavy workloads, or understaffing. Plans may also have trouble finding qualified nurse abstractors to handle abstracting and screening data due to the current tight labor market. Instead of going it alone, it’s worthwhile to hire a third party with ample abstraction and screening resources and experience to avoid falling behind in the coming year. With the right partner, plans are better able to track thorough compliant care documentation in real-time leading to reduced provider abrasion, better member targeting and engagement, and quality score improvement. This data can help fuel a hybrid measure project like the measure related to cervical cancer screenings.
Learn how Cotiviti's Medical Record Retrieval and Abstraction services can offer an integrated approach to data thorough care documentation, reduced provider abrasion, and quality score improvement.
Proactive chart review
Many plans tend to perform chart reviews retroactively, only looking at data collected over the course of a year. But having a year-round strategy that includes both retrospective and prospective chart review allows plans to be more proactive in making changes and engaging members most likely to close gaps, and potentially gaining quality bonuses. After all, the minute that the new measure year arrives, plans can no longer impact the current reporting year’s measure rates.
To get ahead, plans should consider a few different efforts. For example, plans can evaluate areas for improvement by gauging results against internal targets, other plans, and public data. Plans can also assess opportunities for supplemental data that could aid in retrieving data, reducing the burden on manual efforts. Partnering with a third party can also help with retrieval efforts proactively throughout the year, which helps lead to less in season retrieval and abstraction efforts.
With careful preparation in place, plans can make meaningful improvements to their CCS HEDIS measure results—and more importantly, help their members catch disease risk earlier. Stay tuned our next installment of Closing the Gap in February as we focus on preventative heart health.
Get started organizing and analyzing your cervical cancer screening data this year with Cotiviti. Discover how Cotiviti’s solutions are shrinking gaps in care by optimizing member engagement and helping to improve overall Stars Ratings and HEDIS measures.
*HEDIS® is a registered trademark of the National Committee for Quality Assurance.