Healthcare Effectiveness Data and Information Set (HEDIS)

By August 27, 2019Uncategorized

The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures that allows consumers and purchasers to reliably compare health plans.1 HEDIS was established by the National Committee for Quality Assurance (NCQA), a health care accreditor that aims to establish scientifically supported health care, to study how well health plans and doctors implement such research-based care and to identify organizations that make patient care better.2 NCQA partners with the Centers for Medicare & Medicaid Services (CMS) to use HEDIS to allow Medicaid, Medicare and commercial health plans to compare their performance and quality of care with other health plans.3 Specifically, NCQA and CMS use HEDIS measures to evaluate Medicare Advantage (MA) plans, which are Medicare health plans offered by private companies including health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service plans, Special Needs Plans (SNPs) for individuals with disabling conditions and Medicare Medical Savings Account (MSA) plans.4 HEDIS provides a standard way to compare health care plans across the board, ranging from the various types of Medicare Advantage plans to state-wide Medicaid plans to private commercial health plans.3

According to NCQA, HEDIS includes more than 90 measures across six domains: Effectiveness of Care, Access/Availability of Care, Experience of Care, Utilization and Risk Adjusted Utilization, Health Plan Descriptive Information and Measures Collected Usi