The Healthcare Effectiveness Data and Information Set (HEDIS)

Metrics and data

Altogether, HEDIS consists of more than 90 measures across six domains of care. Because their consistent assessments enable standard evaluations across a plethora of managed care organizations, HEDIS makes it possible to compare the performance of health plans on an apples-to-apples basis.

How is data collected?

The process of collecting data is a combination of:

• Defining the reporting population
• Incorporation of HEDIS measurements
• Year-round data management 
• Year-round member and provider outreach in collaboration between Enterprise Clinical Quality Management (ECQM) and the health plan

Data gathered from these efforts is imported into the HEDIS® repository, proofed, and pulled into the certified software vendor library. Audited data is used in administrative measures, to support medical record projects and CAHPS® sample generation. Then, the health plan completes all HEDIS measures designated by NCQA as it relates to Medicaid.

How Healthy Blue uses HEDIS data

The health plan utilizes Health Effectiveness and Data Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) as measurement tools:

• To provide consistent assessment of health plan outcomes and in support of quality improvement strategies using NCQA Quality Compass percentile and state/regulatory benchmarks
• To define and establish the HEDIS® administrative data collection and rate generation process
• To monitor and support quality improvement initiatives through HEDIS® and state performance reporting and support measures for compliance with clinical practice guidelines and clinical and administrative studies
• To ensure comprehensive corporate and health plan collaboration on HEDIS® process projects
• To establish and monitor processes to support accuracy and integrity of information collected and distributed to regulatory state and federal agencies and organizations conducting accreditation such as the National Committee for Quality Assurance (NCQA) or Accreditation Association for Ambulatory Health Care (AAAHC)