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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
206:
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.
220:
340:(HbA1c) level of <7% that was adopted in 2006 for HEDIS 2007. NCQA later decided to not report results of the HbA1c<7% measure publicly in 2008, to modify the HbA1c<7% measure for HEDIS 2009 "by adding exclusions for members within a specific age cohort and with certain comorbid conditions," and to add a new HbA1c<8% measure.
379:
clinically or cost-effective". But, these articles are not necessarily applicable since HEDIS requires Bi or yearly
Diabetic Eye Exams (which include screening for Glaucoma and Optic nerve damage) only for the specific adult patient population of people with Diabetes. This coincides with accepted Ophthalmic care guidelines.
359:
In 2004, a multi-site study determined that persons with persistent asthma per the HEDIS definition at the time had more "asthma-related adverse events" if they were classified by HEDIS as having appropriate asthma therapy than if they did not have appropriate therapy. This cause of this "unexpected"
196:
As of 2019, NCQA is transitioning data collection to a digital process that uses existing electronic data sources rather than surveys and manual data collection. The first six measures available for HEDIS Electronic
Clinical Data System (ECDS) reporting include some related to depression, unhealthy
188:
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
205:
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
111:
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
378:
review ("last assessed as up-to-date" in 2009) concluded that there was "insufficient evidence to recommend population based screening" for glaucoma because no pertinent randomized controlled trials exist. One summary of the
Cochrane review was "population-based screening for glaucoma... is not
155:
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
315:
A 2002 study found "there are numerous non-HEDIS interventions with some evidence of cost effectiveness, particularly interventions to promote healthy behaviors". This may speak more to the specificity of defined healthcare Best
Practices interventions to At Risk Populations than to anecdotal
291:(IOM) report, "HEDIS measures focus largely on processes of care"; the strengths of process measures include the facts that they "reflect care that patients actually receive," thereby leading to "buy-in from providers," and that they are "directly actionable for quality improvement activities".
307:
HEDIS measures do not account for many important aspects of health care quality. They count only a select set of healthcare interventions, for specific at risk patient populations, that can imply that institutions and
Providers are giving adequate care. Its purpose is to verify a minimally
266:
HEDIS measures undergo a selection process that has been described as "rigorous". Steps in the process include assessment of a measure's "importance, scientific soundness and feasibility"; field testing; public comment; a one-year trial period in which results are not reported publicly; and
75:
Employer Data and
Information Set" as of version 1.0 of 1991. In 1993, Version 2.0 of HEDIS was known as the "Health Plan Employer Data and Information Set". Version 3.0 of HEDIS was released in 1997. In July 2007, NCQA announced that the meaning of "HEDIS" would be changed to "Healthcare
47:
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
387:
As stated in the 2006 IOM report, the limitations of HEDIS process measures include "sample size constraints for condition-specific measures," "may be confounded by patient compliance and other factors," and "variable extent to which process measures link to important patient
859:
79:
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.
311:
In 1998, HEDIS measures were said to "offer little insight into... plan’s ability to treat serious illnesses". But, no current studies or evidence can be offered to support this and HEDIS compliance measures are updated yearly to reflect best Practices in
328:
Though without studies, without expressing what interventions and without reporting what "harm", some groups believe attempts by health care providers to improve their HEDIS measures may cause harm to patients. They have not offered any solutions.
984:
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As of 2001, there was concern that the asthma HEDIS measure may "encourag more casual prescribing of controller medications" and may place emphasis "on the prescribing of a controller medication rather than on its actual
347:
because NCQA "works closely with the managed-care industry". Furthermore, approximately half of NCQA's budget is derived from accreditation fees, "which may create an incentive against setting standards too
363:
A 2008 study of 1056 adults with asthma found that "compliance with the HEDIS asthma measure is not favorably associated with relevant patient-oriented outcomes" such as scores on an Asthma Control Test.
351:
The process to develop the measures is not completely "transparent," that is, "information about existing conditions, decisions and actions" is not completely "accessible, visible and understandable”.
370:
screening in older adults" is a current HEDIS measure, the USPSTF found "insufficient evidence to recommend for or against screening adults for glaucoma" in 2005; as of 2008, the
778:
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for hospitalizations, medical office visits and procedures. Survey measures must be conducted by an NCQA-approved external survey organization. Clinical measures use the
621:
Is there a relationship between health outcomes and HEDIS quality performance measures in managed care? Plan-level results from the Medicare Health Outcomes Survey.
483:
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Berger WE, Legorreta AP, Blaiss MS, Schneider EC, Luskin AT, Stempel DA, Suissa S, Goodman DC, Stoloff SW, Chapman JA, Sullivan SD, Vollmer B, Weiss KB.
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A 2001 IOM report noted that "there is incomplete reporting of measures and health plans resulting in lack of representativeness at the national level".
53:
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In some cases, attainment of HEDIS measures is not proven to be associated with better health outcomes. But, no evidence or studies can be offered.
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process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a
152:
care, well-care or preventive visits, inpatient utilization, drug utilization, and distribution of members by age, sex, and product lines.
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775:
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An "Acute Outpatient Depression Indicator" score based on a HEDIS measure predicted improvement in depression severity in one 2005 study.
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interventions with "some evidence". Measures are revised every year to include newer and even more effective Best Practice Guidelines.
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http://blackboard.fresnocitycollege.edu/courses/1/HIT-12-26552-2013SP/content/_1882003_1/HIT%2012%20article%20C4%20MCO%20Data.PDF
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finding was thought to be that some people with intermittent asthma were miscategorized by HEDIS as having persistent asthma.
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The utility of the Health Plan Employer Data and Information Set (HEDIS) asthma measure to predict asthma-related outcomes.
230:
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AHRQ Publication No. 04-0548-A, 2005 March. Rockville, MD: Agency for Healthcare Research and Quality. Accessed 2009 May 6.
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A 2003 study of Medicare managed care plans determined that plan-level health outcomes were associated with HEDIS measures.
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In some studies, attainment of HEDIS measures is associated with cost-effective practices or with better health outcomes.
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HEDIS measures are "widely known and accepted". The NCQA claims that over 90% of U.S. health plans use HEDIS measures.
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According to a 2005 study, HEDIS-Medicaid 3.0 measures covered only 22% of the services recommended by the second
591:
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455:(news release). Washington, D.C.: National Committee for Quality Assurance, 2007 Jul 11. Accessed 2009 Apr 25.
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evaluation of publicly reported measures by "statistical analysis, review of audit results and user comments".
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Disease and Schizophrenia,” and “Adherence to Antipsychotic Medications for Individuals With Schizophrenia.”
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33:
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148:, alcohol and drug dependence treatment, timeliness of handling phone calls, prenatal and postpartum care,
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288:
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HEDIS was described in 1995 as "very controversial". Criticisms of HEDIS measures have included:
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HEDIS prevention performance indicators, prevention quality assessment and Healthy People 2010.
740:
655:
562:
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There is a risk of hypoglycemia if a provider strives to meet the HEDIS measure concerning a
844:
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Washington, D.C.: National Committee for Quality Assurance, 2008 Oct 1. Accessed 2009 May 6.
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Levine RS, Briggs NC, Husaini BA, Foster I, Hull PC, Pamies RJ, Tropez-Sims S, Emerson JS.
433:
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HEDIS data in order to provide HMO services for Medicare enrollees under a program called
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Washington, D.C.: National Committee for Quality Assurance, 2008. Accessed 2009 Apr 25.
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Washington, D.C.: National Committee for Quality Assurance, 2009. Accessed 2009 Apr 25.
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or medical record reviewers who are authorized to review confidential medical records.
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The role of performance measures for improving quality in managed care organizations.
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was attempting to convince the USPSTF to review its statement. Furthermore, a 2006
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The ironic conundrum of the preference sensitive measures, P4P and HEDIS criteria.
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Screening for prevention of optic nerve damage due to chronic open angle glaucoma.
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Lim KG, Patel AM, Naessens JM, Li JT, Volcheck GW, Wagie AE, Enders FB, Beebe TJ.
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J Health Care Poor Underserved 2005 Nov;16(4 Suppl A):64-82. Accessed 2009 May 6.
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Washington, D.C.: National Committee for Quality Assurance. Accessed 2009 Apr 25.
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Washington, D.C.: National Committee for Quality Assurance. Accessed 2009 Apr 25.
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Clinical improvement associated with conformance to HEDIS-based depression care.
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Washington, D.C.: National Committee for Quality Assurance. Accessed 2009 May 6.
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Must good HMOs go bad? Second of two parts. The search for checks and balances.
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In a 2002 study, HEDIS measures "generally reflect cost-effective practices".
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HEDIS data are useful for "evaluating current performance and setting goals".
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treatment for older adults. Other health care concerns covered by HEDIS are
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Cochrane Database of Systematic Reviews 2006 Oct 18;4. Accessed 2009 May 6.
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Abstr AcademyHealth Meet 2003;20:abstract no. 382. Accessed 2009 May 6.
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Ann Allergy Asthma Immunol 2004 Dec;93(6):538-45. Accessed 2009 May 7.
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Performance reports on quality--prototypes, problems, and prospects.
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Health Aff (Millwood) 1996 Spring;15(1):73-85. Accessed 2009 Apr 25.
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acceptable level of care is given to specific At Risk Populations.
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Current management of glaucoma and the need for complete therapy.
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Am J Manag Care 2008 Feb;14(1 Suppl):S20-7. Accessed 2009 May 6.
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HEDIS 2009 summary table of measures, product lines and changes.
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Assessing quality of care via HEDIS 3.0. Is there a better way?
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Ment Health Serv Res 2005 Jun;7(2):103-12. Accessed 2009 May 6.
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Assessing quality of care via HEDIS 3.0. Is there a better way?
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The 90 HEDIS measures are divided into six "domains of care":
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N Engl J Med 1998 May 28;338(22):1635-9. Accessed 2009 May 6.
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N Engl J Med. 1995 Jul 6;333(1):57-61. Accessed 2009 Apr 28.
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Ware J, Rogers W, Gandek B, Haffer SC, Bierman AS, Kang JL.
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Health Serv Res 2001 Jul;36(3):619-41. Accessed 2009 Apr 28.
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Proponents cite the following advantages of HEDIS measures:
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Washington, D.C.: National Committee for Quality Assurance.
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Washington, D.C.: National Committee for Quality Assurance.
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Am J Manag Care 2008 Aug;14(8):487-94. Accessed 2009 May 6.
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Arch Fam Med 1998 Sep-Oct;7(5):410-3. Accessed 2009 Apr 28.
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McKinnon SJ, Goldberg LD, Peeples P, Walt JG, Bramley TJ.
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Arch Fam Med 1998 Sep-Oct;7(5):410-3. Accessed 2009 May 7.
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Transparency standards for diabetes performance measures.
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Rost K, Dickinson LM, Fortney J, Westfall J, Hermann RC.
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Am J Prev Med 2002 Nov;23(4):276-89. Accessed 2009 May 6.
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Measures Collected Using Electronic Clinical Data Systems
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Will integrity of HEDIS data improve with '98 version?
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HEDIS Electronic Clinical Data System (ECDS) Reporting
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Ophthalmology Times 2008 Mar 7. Accessed 2009 May 6.
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Am J Manag Care 2001;7:575-579. Accessed 2009 May 6.
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Envisioning the national health care quality report.
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Measures assessing resource use highlight HEDIS 2008
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JAMA 2009 Jan 14;301(2):210-2. Accessed 2009 May 6.
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Do HEDIS measures reflect cost-effective practices?
184:data collection methodology, as specified by NCQA.
652:Performance measurement: accelerating improvement.
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845:Screening for glaucoma. Recommendation statement.
26:Healthcare Effectiveness Data and Information Set
654:Washington, DC: National Academies Press; 2006.
561:Washington, D.C.: National Academy Press, 2001.
434:Exercising purchasing power for preventive care.
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197:alcohol use, and immunization status.
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968:America's best health plans.
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432:Schauffler HH, Rodriguez T.
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955:2016 HEDIS specification
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650:Institute of Medicine.
606:Neumann PJ, Levine BS.
557:Institute of Medicine.
56:(CMS) requirement that
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530:"The Future of HEDIS"
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92:Effectiveness of Care
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345:conflict of interest
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34:performance measures
486:>WhatIsHEDIS>
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1005:Categories
936:12 October
539:2019-06-21
393:References
388:outcomes".
366:Although "
258:Advantages
323:(USPSTF).
201:Reporting
142:flu shots
84:Structure
893:Archived
860:Archived
828:Archived
779:Archived
744:Archived
711:Archived
675:Archived
513:Archived
491:Archived
468:Archived
449:Archived
417:Archived
376:Cochrane
368:glaucoma
134:diabetes
114:glaucoma
62:Medicare
44:(NCQA).
166:surveys
36:in the
932:. NQCA
658:
565:
348:high".
191:nurses
182:hybrid
138:asthma
126:cancer
333:use".
30:HEDIS
938:2012
656:ISBN
563:ISBN
534:NCQA
172:and
24:The
180:or
73:HMO
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803:^
755:^
686:^
641:^
599:^
548:^
532:.
502:^
405:^
168:,
140:,
136:,
132:,
124:,
68:.
963:.
957:.
940:.
912:.
542:.
248:)
244:(
234:.
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