What is HEDIS and why is it so important?

  • December 21, 2018
  • |Quartz
|
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Understanding HEDIS allows you to better understand your healthcare.

What is HEDIS and why is it so important?

HEDIS® stands for Healthcare Effectiveness Data and Information Set. It is a measurement tool used by more than 90 percent of U.S. health plans to evaluate performance in clinical quality and customer service.

What does HEDIS measure?

Some HEDIS measures focus on prevention like flu shots,breast cancer or other screenings. Other measures focus on the care of people with ongoing health problems, like members with diabetes who need blood sugar tests, eye exams, blood pressure checks and other care.

Some of these measures use information from the claims sent by your doctor; other measures use information from reviewing medical charts. HEDIS also uses information from other sources, such as the Wisconsin Immunization Registry.Many health plans use HEDIS results to guide improvements in quality of care.

How did Quartz do?

Quartz is in the top 5 percent of managed careorganizations in the nation for the following measures –

  • Childhood Immunization Status — (DTap, IPV, MMR,hepatitis B, VZV (chickenpox, varicella, zoster and humanherpesvirus type 3 viruses), pneumococcal conjugate,rotavirus, influenza, combination 2, 3 and 10)
  • Immunizations for adolescents — (human papillomavirus)
  • Breast cancer screening
  • Controlling high blood pressure
  • Statin therapy for patients with cardiovascular disease —received statin therapy
  • Comprehensive diabetes care — (HbA1c testing andHbA1c poor control)
  • Statin therapy for patients with diabetes — received statin therapy
  • Disease modifying anti-rheumatic drug therapy in rheumatoid arthritis
  • Follow-up after hospitalization for mental illness —30-day
  • Follow-up after emergency department visit for alcohol and other drug dependence — 7-day and 30-day visits
  • Timely postpartum care

Quartz is in the top 10 percent of the managed care organizations in the nation for the following measures –

  • Weight assessment / counseling for nutrition / physical activity for children / adolescents — BMI percentile
  • Childhood Immunization Status — (HiB, hepatitis A)
  • Immunizations for adolescents — (Tdap andCombination 2)
  • Colorectal cancer screening
  • Comprehensive diabetes care — (nephropathymonitoring and BP <140/90)
  • Follow-up care for children prescribed attention-deficit /hyperactivity disorder (ADHD) medication — initiation
  • Follow-up after hospitalization for mental illness — 7-day
  • Follow-up after emergency department visit for mental illness — 30- day
  • Avoidance of antibiotic treatment in adults with acute bronchitis
  • Timeliness of prenatal care
  • Use of first-line psycho-social care for children and adolescents on anti-psychotics

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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