Healthcare Effectiveness Data and Information Set

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).

HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. Although not originally intended for trending, HEDIS results are increasingly used to track year-to-year performance. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare Advantage.

HEDIS was originally titled the "HMO Employer Data and Information Set" as of version 1.0 of 1991.[1] In 1993, Version 2.0 of HEDIS was known as the "Health Plan Employer Data and Information Set".[2] Version 3.0 of HEDIS was released in 1997.[1] In July 2007, NCQA announced that the meaning of "HEDIS" would be changed to "Healthcare Effectiveness Data and Information Set."[3]

In current usage, the "reporting year" after the term "HEDIS" is one year following the year reflected in the data; for example, the "HEDIS 2009" reports, available in June 2009, contain analyses of data collected from "measurement year" January–December 2008.[4]

Structure

The 81 HEDIS measures are divided into five "domains of care":[5][6]

<National Committee for Quality Assurance. HEDIS 2015 Technical Specs for Physician Measurement. http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures/HEDIS2015.aspx>

Measures are added, deleted, and revised annually. For example, a measure for the length of stay after giving birth was deleted after legislation mandating minimum length of stay rendered this measure nearly useless. Increased attention to medical care for seniors prompted the addition of measures related to glaucoma screening and osteoporosis treatment for older adults. Other health care concerns covered by HEDIS are immunizations, cancer screenings, treatment after heart attacks, diabetes, asthma, flu shots, access to services, dental care, alcohol and drug dependence treatment, timeliness of handling phone calls, prenatal and postpartum care, mental health care, well-care or preventive visits, inpatient utilization, drug utilization, and distribution of members by age, sex, and product lines.

New measures in HEDIS 2013 are “Asthma Medication Ratio,” “Diabetes Screening for People With Schizophrenia and Bipolar Disorder Who Are Using Antipsychotic Medications,” “Diabetes Monitoring for People With Diabetes and Schizophrenia,” “Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia,” and “Adherence to Antipsychotic Medications for Individuals With Schizophrenia.”

Data collection

HEDIS data are collected through surveys, medical charts and insurance claims for hospitalizations, medical office visits and procedures. Survey measures must be conducted by an NCQA-approved external survey organization. Clinical measures use the administrative or hybrid data collection methodology, as specified by NCQA. Administrative data are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies and labs. For example, a measure titled Childhood Immunization Status requires health plans to identify 2 year old children who have been enrolled for at least a year. The plans report the percentage of children who received specified immunizations. Plans may collect data for this measure by reviewing insurance claims or automated immunization records, but this method will not include immunizations received at community clinics that do not submit insurance claims. For this measure, plans are allowed to select a random sample of the population and supplement claims data with data from medical records. By doing so, plans may identify additional immunizations and report more favorable and accurate rates. However, the hybrid method is more costly, time-consuming and requires nurses or medical record reviewers who are authorized to review confidential medical records.

Reporting

HEDIS results must be audited by an NCQA-approved auditing firm for public reporting. NCQA has an on-line reporting tool called Quality Compass that is available for a fee of several thousand dollars. It provides detailed data on all measures and is intended for employers, consultants and insurance brokers who purchase health insurance for groups. NCQA's web site includes a summary of HEDIS results by health plan. NCQA also collaborates annually with U.S. News & World Report to rank HMOs using an index that combines many HEDIS measures and accreditation status. The "Best Health Plans" list is published in the magazine in October and is available on the magazine's web site. Other local business organizations, governmental agencies and media report HEDIS results, usually when they are released in the fall.

Advantages and disadvantages

Advantages

Proponents cite the following advantages of HEDIS measures:

Disadvantages

HEDIS was described in 1995 as "very controversial".[15] Criticisms of HEDIS measures have included:

References

[NCQA 1] http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2013/HEDIS_2013_October_Update_Final_10.1.12.pdf[28]

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  3. Measures assessing resource use highlight HEDIS 2008 (news release). Washington, D.C.: National Committee for Quality Assurance, 2007 Jul 11. Accessed 2009 Apr 25.
  4. HEDIS 2010 public comment overview. Washington, D.C.: National Committee for Quality Assurance, 2009. Accessed 2009 Apr 25.
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  13. 13.0 13.1 13.2 Institute of Medicine. Performance measurement: accelerating improvement. Washington, DC: National Academies Press; 2006. ISBN 978-0-309-10007-6. Accessed 2009 Apr 28.
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  28. http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2013/HEDIS_2013_October_Update_Final_10.1.12.pdf
  1. /WhatisHEDIS. "What Is HEDIS". What Is HEDIS. NQCA. Retrieved 12 October 2012.

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