The Healthcare Effectiveness Data and Information Set (HEDIS) was developed and maintained by the National Committee for Quality Assurance (NCQA) and has become one of the most widely used set of performance measures in managed care. HEDIS reporting is a requirement of health plans by NCQA and the Centers for Medicare and Medicaid Services (CMS) for use in health plan accreditation, Star Ratings, and regulatory compliance.
HEDIS data is collected through a combination of surveys, medical record audits, and claims data. The data collected provides information regarding customer satisfaction, specific health care measures, and structural components that ensure quality of care. An outlined set of performance measures across 6 domains of care is required for reporting: Effectiveness of Care, Access/Availability of Care, Experience of Care, Utilization and Risk-Adjusted Utilization, Health Plan Descriptive Information, and Measures Collected Using Electronic Data Systems.
It is important to understand the HEDIS requirements in order to improve measure performance and quality of care. Each component is affected by physicians, pharmacists, office staff, medical staff, and health plan employees. With an emphasis on and focused efforts towards patient care, we can create positive outcomes regarding HEDIS.