Healthcare Effectiveness Data and Information Set

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HEDIS 2006 Volume 2: Technical Specifications

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).

HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. Although not originally intended for trending, HEDIS results are increasingly used to track year-to-year performance. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare Advantage.

HEDIS was originally titled the "HMO Employer Data and Information Set" as of version 1.0 of 1991.[1] In 1993, Version 2.0 of HEDIS was known as the "Health Plan Employer Data and Information Set".[2] Version 3.0 of HEDIS was released in 1997.[1] In July 2007, NCQA announced that the meaning of "HEDIS" would be changed to "Healthcare Effectiveness Data and Information Set."[3]

In current usage, the "reporting year" after the term "HEDIS" is one year following the year reflected in the data; for example, the "HEDIS 2009" reports, available in June 2009, contain analyses of data collected from "measurement year" January–December 2008.[4]


The 75 HEDIS measures are divided into six "domains of care":[5][6]

<National Committee for Quality Assurance. HEDIS 2015 Technical Specs for Physician Measurement.>

Measures are added, deleted, and revised annually. For example, a measure for the length of stay after giving birth was deleted after legislation mandating minimum length of stay rendered this measure nearly useless. Increased attention to medical care for seniors prompted the addition of measures related to glaucoma screening and osteoporosis treatment for older adults. Other health care concerns covered by HEDIS are immunizations, cancer screenings, treatment after heart attacks, diabetes, asthma, flu shots, access to services, dental care, alcohol and drug dependence treatment, timeliness of handling phone calls, prenatal and postpartum care, mental health care, well-care or preventive visits, inpatient utilization, drug utilization, and distribution of members by age, sex, and product lines.

New measures in HEDIS 2013 are “Asthma Medication Ratio,” “Diabetes Screening for People With Schizophrenia and Bipolar Disorder Who Are Using Antipsychotic Medications,” “Diabetes Monitoring for People With Diabetes and Schizophrenia,” “Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia,” and “Adherence to Antipsychotic Medications for Individuals With Schizophrenia.”[citation needed]

Data collection[edit]

HEDIS data are collected through surveys, medical charts and insurance claims for hospitalizations, medical office visits and procedures. Survey measures must be conducted by an NCQA-approved external survey organization. Clinical measures use the administrative or hybrid data collection methodology, as specified by NCQA. Administrative data are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies and labs. For example, a measure titled Childhood Immunization Status requires health plans to identify 2 year old children who have been enrolled for at least a year. The plans report the percentage of children who received specified immunizations. Plans may collect data for this measure by reviewing insurance claims or automated immunization records, but this method will not include immunizations received at community clinics that do not submit insurance claims. For this measure, plans are allowed to select a random sample of the population and supplement claims data with data from medical records. By doing so, plans may identify additional immunizations and report more favorable and accurate rates. However, the hybrid method is more costly, time-consuming and requires nurses or medical record reviewers who are authorized to review confidential medical records.


HEDIS results must be audited by an NCQA-approved auditing firm for public reporting. NCQA has an on-line reporting tool called Quality Compass that is available for a fee of several thousand dollars. It provides detailed data on all measures and is intended for employers, consultants and insurance brokers who purchase health insurance for groups. NCQA's web site includes a summary of HEDIS results by health plan. NCQA also collaborates annually with U.S. News & World Report to rank HMOs using an index that combines many HEDIS measures and accreditation status. The "Best Health Plans" list is published in the magazine in October and is available on the magazine's web site. Other local business organizations, governmental agencies and media report HEDIS results, usually when they are released in the fall.

Advantages and disadvantages[edit]


Proponents cite the following advantages of HEDIS measures:


HEDIS was described in 1995 as "very controversial".[15] Criticisms of HEDIS measures have included:


[NCQA 1][28]

  1. ^ a b Mainous AG 3rd, Talbert J. Assessing quality of care via HEDIS 3.0. Is there a better way? Arch Fam Med 1998 Sep-Oct;7(5):410-3. Accessed 2009 Apr 28.
  2. ^ Schauffler HH, Rodriguez T. Exercising purchasing power for preventive care. Health Aff (Millwood) 1996 Spring;15(1):73-85. Accessed 2009 Apr 25.
  3. ^ Measures assessing resource use highlight HEDIS 2008 (news release). Washington, D.C.: National Committee for Quality Assurance, 2007 Jul 11. Accessed 2009 Apr 25.
  4. ^ HEDIS 2010 public comment overview. Washington, D.C.: National Committee for Quality Assurance, 2009. Accessed 2009 Apr 25.
  5. ^>WhatIsHEDIS>What is HEDIS? Washington, D.C.: National Committee for Quality Assurance. Accessed 2009 Apr 25.
  6. ^ a b HEDIS 2009 summary table of measures, product lines and changes. Washington, D.C.: National Committee for Quality Assurance, 2008. Accessed 2009 Apr 25.
  7. ^ a b c Institute of Medicine. Envisioning the national health care quality report. Washington, D.C.: National Academy Press, 2001. ISBN 0-309-07343-X. Accessed 2009 May 6.
  8. ^ HEDIS life cycle. Washington, D.C.: National Committee for Quality Assurance. Accessed 2009 May 6.
  9. ^ Scanlon DP, Darby C, Rolph E, Doty HE. The role of performance measures for improving quality in managed care organizations. Health Serv Res 2001 Jul;36(3):619-41. Accessed 2009 Apr 28.
  10. ^ a b Neumann PJ, Levine BS. Do HEDIS measures reflect cost-effective practices? Am J Prev Med 2002 Nov;23(4):276-89. Accessed 2009 May 6.
  11. ^ Ware J, Rogers W, Gandek B, Haffer SC, Bierman AS, Kang JL. Is there a relationship between health outcomes and HEDIS quality performance measures in managed care? Plan-level results from the Medicare Health Outcomes Survey. Abstr AcademyHealth Meet 2003;20:abstract no. 382. Accessed 2009 May 6.
  12. ^ Rost K, Dickinson LM, Fortney J, Westfall J, Hermann RC. Clinical improvement associated with conformance to HEDIS-based depression care. Ment Health Serv Res 2005 Jun;7(2):103-12. Accessed 2009 May 6.
  13. ^ a b c Institute of Medicine. Performance measurement: accelerating improvement. Washington, DC: National Academies Press; 2006. ISBN 978-0-309-10007-6. Accessed 2009 Apr 28.
  14. ^ What is HEDIS? Washington, D.C.: National Committee for Quality Assurance. Accessed 2009 Apr 25.
  15. ^ a b Epstein A. Performance reports on quality--prototypes, problems, and prospects. N Engl J Med. 1995 Jul 6;333(1):57-61. Accessed 2009 Apr 28.
  16. ^ Mainous AG 3rd, Talbert J. Assessing quality of care via HEDIS 3.0. Is there a better way? Arch Fam Med 1998 Sep-Oct;7(5):410-3. Accessed 2009 May 7.
  17. ^ Levine RS, Briggs NC, Husaini BA, Foster I, Hull PC, Pamies RJ, Tropez-Sims S, Emerson JS. HEDIS prevention performance indicators, prevention quality assessment and Healthy People 2010. J Health Care Poor Underserved 2005 Nov;16(4 Suppl A):64-82. Accessed 2009 May 6.
  18. ^ Glauber JH. Does the HEDIS asthma measure go far enough? Am J Manag Care 2001;7:575-579. Accessed 2009 May 6.
  19. ^ a b Aron D, Pogach L. Transparency standards for diabetes performance measures. JAMA 2009 Jan 14;301(2):210-2. Accessed 2009 May 6.
  20. ^ HEDIS 2009, volume 2: technical update. Washington, D.C.: National Committee for Quality Assurance, 2008 Oct 1. Accessed 2009 May 6.
  21. ^ Kuttner R. Must good HMOs go bad? Second of two parts. The search for checks and balances. N Engl J Med 1998 May 28;338(22):1635-9. Accessed 2009 May 6.
  22. ^ a b Berger WE, Legorreta AP, Blaiss MS, Schneider EC, Luskin AT, Stempel DA, Suissa S, Goodman DC, Stoloff SW, Chapman JA, Sullivan SD, Vollmer B, Weiss KB. The utility of the Health Plan Employer Data and Information Set (HEDIS) asthma measure to predict asthma-related outcomes. Ann Allergy Asthma Immunol 2004 Dec;93(6):538-45. Accessed 2009 May 7.
  23. ^ Lim KG, Patel AM, Naessens JM, Li JT, Volcheck GW, Wagie AE, Enders FB, Beebe TJ. Flunking asthma? When HEDIS takes the ACT. Am J Manag Care 2008 Aug;14(8):487-94. Accessed 2009 May 6.
  24. ^ U.S. Preventive Services Task Force (USPSTF). Screening for glaucoma. Recommendation statement. AHRQ Publication No. 04-0548-A, 2005 March. Rockville, MD: Agency for Healthcare Research and Quality. Accessed 2009 May 6.
  25. ^ Lobbyist outlines glaucoma-related initiatives. Ophthalmology Times 2008 Mar 7. Accessed 2009 May 6.
  26. ^ Hatt SR, Wormald R, Burr J. Screening for prevention of optic nerve damage due to chronic open angle glaucoma. Cochrane Database of Systematic Reviews 2006 Oct 18;4. Accessed 2009 May 6.
  27. ^ McKinnon SJ, Goldberg LD, Peeples P, Walt JG, Bramley TJ. Current management of glaucoma and the need for complete therapy. Am J Manag Care 2008 Feb;14(1 Suppl):S20-7. Accessed 2009 May 6.
  28. ^
  1. ^ /WhatisHEDIS. "What Is HEDIS". What Is HEDIS. NQCA. Retrieved 12 October 2012. 

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