Who’s Behind the HEDIS?
Many HEDIS abstractors, health plan representatives, and providers are aware that the annual HEDIS, or Healthcare Effectiveness Data and Information Set, is used to measure and compare health plan performance. As each health care professionals affected by yearly HEDIS collection and results delves deeper into the details of the measures involved, strategizes how best to document the information necessary to receive high marks, or consider how to extract that information from medical records, many might question how HEDIS came to be.
The HEDIS is the brainchild of the National Committee for Quality Assurance (NCQA). Founded in 1990, the NCQA is a non-profit organization dedicated to improving healthcare in the United States and elevating health care quality to an issue of primary national concern. They accomplish this goal primarily via data collection and presentation. A health plan interested in receiving accreditation through the NCQA must submit information from medical records and other documents detailing patient care and provider performance. This information is then compiled and made available to the public. Because almost every American health plan seeks NCQA accreditation, the data set generated presents an accurate picture of health care throughout the United States.
Why Track Healthcare Data?
Initially, HEDIS results were designed to help consumers make an informed decision when choosing from among the many health plan options available. This remains an important aspect of the NCQA’s mission. Each year, HEDIS results are used by the NCQA to compile report cards for every participating health plan. These report cards allow consumers to directly compare how health plans have performed in a number of key categories. Health plans also use HEDIS to see how they are performing in relation to their peers. They can use HEDIS results to identify successes as well as areas for improvement and to set defined goals for future growth.
Continuing Evolution
The NCQA recognizes that medicine and healthcare are continually evolving. They work with physicians, nurses and administrators to evaluate the HEDIS every year and alter it if necessary. If a new law makes a given measure obsolete, the NCQA will delete that measure so providers do not have to capture irrelevant information. If a new treatment proves effective for a condition included in HEDIS measures, the NCQA will adjust its expectations to incorporate that new treatment. This commitment to remaining relevant in a rapidly changing field is an important aspect of both the HEDIS and the National Committee for Quality Control.
Considerable work is required to collect the data necessary to compile the HEDIS each year. If you are a health plan representative who is eager to ensure compliance with HEDIS standards or a nurse interested in working to improve the quality of American health care, consider visiting HEDIS Nurses to see how you can support the NCQA’s valuable mission.
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