HEDIS (Healthcare Effectiveness Data and Information Set) is an important tool that is developed by the National Committee for Quality Assurance (NCQA) for assessing healthcare provided to consumers. It is used by more than ninety per cent of U.S. health plans. HEDIS comprises 75 measures across 8 domains of care that enable health plans to evaluate what percentage of their members is compliant with particular treatment protocols, especially with regard to chronic conditions. It also helps health plans to formulate the best practices for preventative care.
The data collection methods include Administrative, Hybrid and Survey. All HEDIS results have to be audited by a firm approved by the NCQA for public reporting. The results are included in Quality Compass, a web-based tool that enables users to view the results. Data collection may include reviewing medical records even far back as 10 years.
In the Administrative methodology, health plans have to identify the eligible candidates for the particular HEDIS measure. Data is collected from insurance claims and registration systems in medical offices, clinics, hospitals, labs and pharmacies. Health plans will also have to find out the number of eligible candidates who have received the particular service required for that measure. Administrative data collection captures measures such as breast cancer screening and anti depressant medication management.
In the Hybrid method, a random selection is made of eligible candidates. This methodology helps to supplement Administrative data with data collected via medical record reviews. Measures in which this methodology is used include comprehensive diabetes care, childhood immunizations and pre-natal and post partum care.
The CAHPS Survey is used to measure members’ satisfaction with the care provided to them in areas such as customer service, claims processing and speed with which the required care was provided. This survey is conducted by an NCQA approved external survey organization.
HEDIS data is beneficial to the health plans, managed care industry as well as consumers. While the health plans use the data to gain insight into areas where quality improvement efforts are to be made, the managed care industry utilizes it to compare performance between health plans. Consumers are also benefited by this data because it will help them select a health plan that best meets their needs.
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