Quality control in healthcare is absolutely essential, to ensure all patients have the opportunity to access the best care. The level of care someone receives under their health plan does not just come down to the individual doctors they see, but a whole host of other factors, including the structures and processes in place around their care. A lot of different incentives and other measures are in place to improve quality in healthcare and to regulate it nationwide, however monitoring quality and comparing health plans on a basis of quality requires a lot of data.

This is where HEDIS comes in. HEDIS stands for Healthcare and Effectiveness Data and Information Set, and it has existed since 1991 when it was created by the National Committee for Quality Assurance (NCQA). Here, we take a look at what HEDIS actually is, and why it is so important:

Understanding HEDIS?

HEDIS is a huge data set that is released annually. It stores all kinds of data on everything from the percentage of heart patients prescribed with beta blockers to data on breast cancer screening. There are currently 71 different metric included in HEDIS, and these are divided into areas of relevance or ‘domains’, which include the availability of care, the effectiveness of care, descriptive information about health plans, resource use and experience of care. HEDIS data is used by the vast majority of American health plans, estimated at 90%. To ensure data stays as relevant and useful as possible, the metrics included are reviewed on an annual basis by the Committee on Performance Measurement, which aims to continually improve and evolve HEDIS.

How Is HEDIS Used?

In Healthcare, data is one of the most important resources there is, as it can identify areas that can be improved, and where certain behaviors appear to lead to better outcomes. All data included in HEDIS reporting is audited by the NCQA, so that recommendations can be made. This happens on an annual cycle, with data for the first half of each year audited with a view to improvements being visible in the latter half of the year. HEDIS is also used to create rankings, and every fall a ranked list of HMOs is released, in partnership between the NCQA and US News & World Report. Another significant use of HEDIS data is in producing the yearly State of Healthcare Quality Report, which draws on HEDIS data to make overall assessments of the healthcare industry in America.

Data Analysis

Of course, any mass data set is only as useful as the analysis done on it, and so the way HEDIS data is analyzed is as important as the data gathering in terms of the NCQA’s objectives for continuous improvement in healthcare. By annually looking at their own processes and effectiveness they can continuously refine the way HEDIS is used, making it an evolving and ever more important tool.

HEDIS has been around for 25 years this year, and has become an integral part of health plan quality.


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