HEDIS Measures and the Impact on Our Healthcare

HEDIS AbstractorsHEDIS measures mean more work for health plan providers, HEDIS nurses, and HEDIS abstractors, but better care for consumers

HEDIS stands for Healthcare Effectiveness Data and Information Set. Basically, it is a set of performance and reporting measures designed to allow patients and employers to see how well their health plan compares to other plans as well as to regional or national benchmarks with regard to various domains of care. These domains of care include things like quality of care, access to care, and patient satisfaction.

Skilled HEDIS nurses and HEDIS abstractors are vital to this process because their work provides the data used as basis for the comparisons. HEDIS measures are constantly evolving and impact our healthcare in many different ways.

Improving Health Plan Offerings

First of all, the very fact that HEDIS measures exist at all pushes all health plans to excel. Knowing that the consumer is empowered to see how their health plan measures up against other plans using convenient tools like HEDIS Quality Compass, plan providers must strive to improve their offerings or else lose their customers to better plans.

Improving Care

HEDIS measures relating to quality of care are developed with the intention of ensuring that patients get the right amount and type of care for a given medical condition. This means that each HEDIS measure must be backed by scientific data and submitted to rigorous testing in order to prove it represents the best care before it can be adopted. HEDIS keeps track of how often different treatments are prescribed and how effective the outcome is and then updates their treatment benchmarks to adjust to new scientific knowledge and discoveries as needed.

Providing Fair Comparisons

The reason we can compare health plans so effectively using HEDIS is that there are strict rules for the reporting of data, the administering of patient surveys, and other activities. For example, HEDIS abstractors follow a set process for getting the data out of patient charts, no matter which plan or provider they are evaluating, and all patients take the same HEDIS surveys to give their opinions about patient care. This equality in methodology ensures that conclusions based on the data will be fair. HEDIS reporting ensures that comparing one provider to another is like comparing apples to apples, not apples to oranges.

Providing Accreditation

All health plans that want to provide services for Medicare enrollees who have purchased Medicaid Advantage must use HEDIS nurses and HEDIS abstractors to comply with HEDIS reporting requirements, and many other health plans voluntarily comply with these requirements in order to receive accreditation from the National Committee for Quality Assurance. Without HEDIS, the accreditation process would likely not be as fair, meaningful, and useful to consumers.