What’s HEDIS® and Why is it Important?

  • December 22, 2016
  • |Quartz
|
HEDIS® stands for Healthcare Effectiveness Data and Information Set. It is the measurement tool used by more than 90 percent of the nation’s health plans to evaluate their performance in terms of clinical quality and customer service.

Altogether, HEDIS® includes 81 measures across five domains of care. All the measures are the same for all health plans, which makes it possible to compare the performance of health plans on an “apples-to-apples” basis.

Some HEDIS measures focus on prevention, such as how many health plan members get a flu shot, get screened for breast cancer and so on. Other data looks at how people with chronic health problems are taken care of. For example, there is a standard of care for managing diabetes which means that blood sugar tests are done on schedule, blood pressure is checked and is within an acceptable range, that eye exams are performed when they should be and so on.

Some measures use data collected from Unity claims. Other measures use data collected through claims plus medical chart review. HEDIS can also use other data sources such as the Wisconsin Immunization Registry (WIR). Health plans may use HEDIS measures to focus efforts on quality improvement initiatives.

Unity is in the top 5 percent of managed care organizations in the nation for the following measures – Unity is in the top 10 percent of managed care organizations in the nation for the following measures –
Influenza vaccine Childhood Immunizations: DTaP, Hepatitis B, Pneumococcal, Rotavirus
Adolescent Immunizations: Tdap / TD Cervical Cancer Screening
Human Papillomavirus Vaccine for Female Adolescents Asthma Medication Ratio, 19-50 year olds and 5-85 year olds
Breast Cancer Screening Controlling High Blood Pressure
Colorectal Cancer Screening Comprehensive Diabetes Care, Blood Pressure <140 / 90
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis Follow-Up Care for Children Prescribed Attention-Deficit / Hyperactivity Disorder (ADHD) Medication, Initiation
Follow-Up After Hospitalization for Mental Illness: 30 days, 7 days Annual Monitoring for Patients on Persistent Medications, Digoxin, Diuretics, Combined
Annual Monitoring for Patients on Persistent
Medications, ACE Inhibitors or ARBs
Monitoring for Patients on Persistent Medications: ACE Inhibitors or ARBs, Digoxin
Postpartum Care Non-Recommended Cervical Cancer Screening in Adolescent Females
  Children and Adolescents Access to Primary Care Practitioners, 12-24 months

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