HEDIS
Why it matters
NCQA (National Committee for Quality Assurance) established Healthcare Effectiveness Data and Information Set (HEDIS) as a comprehensive set of standardized performance measures to provide purchasers and consumers with the information required to compare health plan performance. HEDIS measures clinical quality and customer service, requiring standardized reporting under 5 domains of care:
1. Effectiveness of Care
2. Access/Availability of Care
3. Experience of Care
4. Utilization and Risk Adjusted Utilization
5. Health Plan Descriptive Information
2. Access/Availability of Care
3. Experience of Care
4. Utilization and Risk Adjusted Utilization
5. Health Plan Descriptive Information
6. Measures collected using Electronic clinical data Systems
HEDIS matters and impacts our ability to attract and maintain membership.
Please use the below links related to HEDIS reporting and Quality Improvement:
- PCP P4P Program
- Quality Rules – This document provides an overview of our ambulatory clinical guidelines as well as HEDIS reporting specs.
- HEDIS Pocket Guide – Condensed version of HEDIS reporting codes.
- Gaps in Care Portal
- “Red” Talks
- 2021 Calendar of Events – Coming Soon
- Diabetes Awareness and Prenatal & Postpartum Care
- Breast Cancer and Dental Awareness
- Quality Newsletters
