The Healthcare Effectiveness Data and Information Set is a performance measurement tool for health plans and other healthcare organizations.
Five things to know about HEDIS:
1. About 190 million people are enrolled in health plans that report HEDIS results, according to the National Committee for Quality Assurance, which designed HEDIS.
2. NCQA requires organizations to submit HEDIS measures each year, along with the Consumer Assessment of Healthcare Providers and Systems Health Plan survey. NCQA also uses HEDIS as part of its annual ranking of health plans.
3. HEDIS spans more than 90 measures across six areas of care: effectiveness of care, access/availability of care, experience of care, utilization and risk-adjusted utilization, health plan descriptive information, and measures collected using electronic clinical data systems.
4. In 2019, HEDIS added three measure to its 2019 accreditation scoring: metabolic monitoring for children and adolescents on antipsychotics (commercial and Medicaid); use of first-line psychosocial care for children and adolescents on antipsychotics (commercial and Medicaid); and the timeliness of prenatal care rate (commercial).
5. Healthcare organizations can use HEDIS measures for internal, noncommercial purposes, such as internal quality improvement activities. They have to purchase the appropriate license to use the data. If an organization wants to make its HEDIS results public, they must follow the right disclaimers.