The Healthcare Effectiveness Data and Information Set (HEDIS®) is a set of managed care performance measures developed by the National Committee for Quality Assurance (NCQA).
Here are a few quick facts about HEDIS.
- A measurement tool used by health plans to evaluate performance in terms of clinical quality and customer service.
- Coordinated and administered by NCQA and used by the Centers for Medicare and Medicaid Services (CMS) for monitoring the performance of managed care organizations.
- All managed care companies that are NCQA‐accredited perform HEDIS reviews during the same time each year.
- A subset of HEDIS measures is collected and reported for the healthcare exchanges product lines.
- A retrospective review of services and performance of care.
Each year NCQA sets a deadline in May for health plans to complete HEDIS data collection. Here is a look at the calendar.
Annual HEDIS calendar
- January to May — Clinical Quality staff initiates medical record requests and collection from providers.
- June — Results are reported to NCQA.
- July — NCQA releases Quality Compass® commercial edition.
- August — Projected health plan ratings for commercial, Medicaid, and Medicare are released.
- September and October — NCQA releases Quality Compass® Medicaid and Medicare editions. Final health plan results are posted to NCQA’s website.
Remember HEDIS data is collected four ways:
- Administrative: Data is collected from claims, encounter, eligibility, and provider data.
- Hybrid: Data is collected from claims and medical record reviews.
- Survey: Data is collected from member and provider surveys.
- Electronic Clinical Data (ECDS): Data is collected from electronic sources (EHRs, HIEs/clinical registries, case management, and administrative claims processing systems).
For more HEDIS information click here to read HEDIS 101 Datasheet.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).