HEDIS

HEDIS (Healthcare Effectiveness Data and Information Set) 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 HEDIS is a tool created by the managed care industry, its use has spread to other healthcare organizations, including third-party administrators, medical group practices, and hospitals.

Overview

HEDIS consists of 81 measures across 5 domains of care. These domains include:

• Effectiveness of Care
• Access/Availability of Care
• Experience of Care
• Utilization and Risk Adjusted Utilization
• Health Plan Descriptive Information

HEDIS measures are used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis.

HEDIS Measures

HEDIS measures cover a wide range of health issues, from preventive care to chronic condition management. Some of the measures include:

• Breast cancer screening
• Colorectal cancer screening
• Diabetes care
• High blood pressure management
• Childhood immunization status
• Prenatal and postpartum care
• Antidepressant medication management
• Access to mental health care

Use of HEDIS

HEDIS data are used in multiple ways to improve healthcare. Health plans use the data to identify areas for improvement and to track their performance over time. Consumers and employers use HEDIS data to choose the best health plan for their needs. Researchers use the data to study health care trends and outcomes.

Criticisms of HEDIS

While HEDIS has been instrumental in improving the quality of healthcare, it is not without its criticisms. Some critics argue that HEDIS measures do not adequately capture the quality of care, as they focus on process rather than outcomes. Others argue that the measures are too focused on primary care and do not adequately address specialty care.

See Also

• National Committee for Quality Assurance
• Managed Care
• Healthcare Quality

HEDIS Resources
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