How does HEDIS get data?

It seems like a pretty basic question, but a lot of people don’t think about it—how does HEDIS get data?

First let’s back up a step or two. HEDIS stands for Healthcare Effectiveness Data and Information Set. It was created and is administered by the NCQA—the National Committee for Quality Assurance, which accredits healthcare organizations. It’s used by the Centers for Medicare and Medicaid (CMS) to monitor the performance of healthcare organizations. Results are also used for organizations to realize areas where improvement has occurred or needs to occur in the future. Training of providers and members sometimes happens after HEDIS data sets are published.

HEDIS data is collected from healthcare providers in three ways: administrative data (acquired from the providers’ claims database), hybrid data (from the claims database and medical record reviews), and survey data (from member and provider surveys).

HEDIS data collection is permitted because the Health Information Portability and Accountability Act (HIPAA) Privacy Rule that has passed in both houses of the United States Congress. The release of this information requires no special patient authorization. No personal identifying information is released—all of the data is reported collectively without individual identifiers.

Each year, from January-May 15, clinical quality staff collects HEDIS data through medical record reviews. Then in June, results are reported to the NCQA. From July-October, the NCQA releases Quality Compass results nationwide. The commercial edition is published in July, and in September and October, the Medicaid and Medicare editions are released.

Does this sound interesting to you? Call (877) 328-2343 or email info@datafied.com to find out more and potentially join the HEDIS team.