By RaeAnn Grossman

 

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.

HEDIS is…

  • 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:

  1. Administrative: Data is collected from claims, encounter, eligibility, and provider data.
  2. Hybrid: Data is collected from claims and medical record reviews.
  3. Survey: Data is collected from member and provider surveys.
  4. 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).