Healthcare Effectiveness Data and Information Set

HEDIS-2006-Vol-2

Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the United States, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health care service and performance among health insurance plans. The HEDIS measures cover a broad range of important health issues, including many aspects of primary care, mental health services, cancer screening, cardiovascular care, and care for those with chronic illnesses.

Overview

HEDIS consists of a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of health care plans. The measures relate to many significant public health issues such as cancer, heart disease, smoking, asthma, and diabetes. Health plans can earn accreditation from the NCQA by demonstrating their performance on these measures.

Components

HEDIS measures performance in health care where improvements can significantly affect health outcomes. The set includes measures for:

• Effectiveness of Care
• Access/Availability of Care
• Experience of Care
• Utilization and Risk Adjusted Utilization
• Health Plan Descriptive Information

Each category encompasses a variety of specific measures. For example, the Effectiveness of Care category includes measures for cancer screenings, diabetes care, and heart care.

Data Collection

Data for HEDIS measures come from a variety of sources including insurance claims, Electronic Health Records (EHRs), and surveys of patients' experiences. The comprehensive nature of the data collection process ensures a broad and accurate representation of a health plan's performance.

Usage

HEDIS scores are used by health plans to see where they can improve and by consumers to choose a health plan. Employers, consultants, and government agencies also use HEDIS data to select health plans and to hold them accountable for their performance.

Challenges and Criticisms

While HEDIS is a powerful tool for comparing health plan performance, it is not without its challenges and criticisms. Some argue that the focus on measurable outcomes can lead to a "teaching to the test" phenomenon in health care, where providers focus on metrics at the expense of other aspects of care. Additionally, the complexity and cost of data collection for HEDIS can be significant burdens for smaller health plans.

Future Directions

The NCQA continues to update and refine HEDIS measures in response to changing health care priorities and the availability of new medical evidence. There is also a growing emphasis on measures that assess outcomes and patient experiences, in addition to traditional process measures.