HEDIS^® P4P Audit Reviews

HealthcareData Company (HDC) is a frontrunner in the emerging area of P4P (Pay for Performance) audit reviews, a California statewide initiative that uses standard HEDIS measures to evaluate the performance of contracted physician organizations (POs). The goals of this effort include development of a common set of measures for POs, publicly reporting the scores, and financially rewarding POs that consistently demonstrate high levels of performance.

Working with the California Association of Provider Groups, HDC took the lead in developing customized audit contracts for Association members. As a result, we now have extensive experience in PO auditing. HDC has also worked closely with NCQA on data submission protocols and reporting requirements.

The PO audit reviews primarily focus on:

• ensuring accurate, reliable, publicly reportable data that can be used to compare POs;
• verifying that measure production processes conform to technical specifications;
• measuring information system capabilities and evaluating ability to process medical, member and practitioner information to accurately report clinical measures; and
• ensuring consistency across audit reviews by having an NCQA Licensed Organization (such as HDC) and a Certified HEDIS Compliance Auditor (such as the senior auditors used by HDC) conduct the audit review.

The final audit review report of the PO includes:

• the scope of the audit indicating the measures reported;
• a summary of offsite activities, including auditor strategy and considerations;
• results and rationales for the P4P measures;
• a summary of auditor findings on each IS standard;
• the audit review statement;
• audit designations, associated rates and rationales; and
• descriptive information about the PO reviewed and about HDC and its assigned audit staff.

Please refer to other pages on our website for more information about our overall HEDIS audit philosophy, our process and methodology, audit timeline information, our auditors and audit references. The matters covered on these other pages have direct applicability to our P4P audit work.