How many health plans use HEDIS?

More than 90 percent of health plans—HMOs, POS plans, and PPOs—use HEDIS to measure performance. HEDIS is managed by the National Committee for Quality Assurance (NCQA), a private, non-profit organization that accredits and certifies health care organizations.

How is HEDIS data used by health plans?

Employers and individuals use HEDIS to measure the quality of health plans. HEDIS measures how well health plans give service and care to their members. They report the data to the National Committee for Quality Assurance (NCQA), which rates health plans based on more than 90 measures across six areas of care.

What is the measurement year for HEDIS?

2020
HEDIS® Measurement Year 2020 – continuing the pursuit of a core set of meaningful measures. The National Committee for Quality Assurance (NCQA) HEDIS® set of quality measures is considered by many to be the gold standard when it comes to quality measurement.

Why is HEDIS important to health plans?

For health plans, HEDIS ratings can be very important. The scores on measures can help them understand quality of care being delivered to their members in some of the most common chronic and acute illnesses. Higher scores can help compete more effectively in various markets.

How is HEDIS calculated?

a) The HEDIS individual measure scores are calculated as proportional rates using the numerators and denominators that are reported per the NCQA measurement requirements. Measures will be dropped from star rating calculations and benchmarks if at least 50% of California plans cannot report a valid rate.

Is Cahps part of HEDIS?

NCQA uses the CAHPS Health Plan Survey 5.0 as part of the Experience of Care domain of HEDIS® (the Healthcare Effectiveness Data and Information Set), a set of health plan performance measures used for both public reporting and accreditation.

What is HEDIS CAHPS?

HEDIS CAHPS for Health Plans Survey Vendor Certification. The NCQA Survey Vendor Certification Program helps ensure health plans get as accurate data as possible about its members’ experience. It evaluates, trains and certifies private market research firms to administer the HEDIS CAHPS survey on behalf of health plans …

Who collects hedis data?

NCQA
Most HEDIS data is 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.

What are the HEDIS quality measures?

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used group of measures that quantify quality performance among healthcare payers and providers in any given year. Some common HEDIS quality measures involve childhood immunization status, cancer screenings, asthma medication management,…

What does HEDIS stand for?

HEDIS(pronounced he´-dus) stands for Healthcare Effectiveness Data and Information Set. Employers and individuals use HEDIS to measure the quality of health plans. HEDIS measures how well health plans give service and care to their members.

What are HEDIS gaps?

HEDIS Helps Payers Close Gaps in Care. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used for health care performance measurement. Called the “Gold Standard” by the NCQA , HEDIS is used by 90% of Health Plans in the country. HEDIS is important because it standardizes how plans collect, audit and report critical clinical data.

What is HEDIS chart review?

A HEDIS chart review is when the National Committee for Quality Assurance (NCQA) reviews a patient’s medical records to determine if the quality of care measures have been met. Medical chart reviews are also the data source used by the NCQA to determine any incentives or financial rewards for health plans.