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NCQA Reports Based on HEDIS Measures

by | HEDIS

What is HEDIS?

HEDIS is a performance measurement tool with the main goal of ultimately improving healthcare for all patients. HEDIS evaluates a healthcare plan’s ability to demonstrate improvement in its care and quality measures. It also provides a picture of the overall health and wellness of the plan’s members or patients. HEDIS allows for identification in gaps of care and development of programs and interventions to assist with increasing compliance and improving health outcomes.

How is data collected?

HEDIS professionals collect data for the HEDIS measures multiple ways. Information from claims or encounters, and from hospital visits and clinic appointments are documented. Data from procedures, laboratory tests, and the pharmacy are also collected. Data can also be taken from a patient’s medical record. Surveys can similarly be utilized to gather information for the measure, such as the CAHPs Survey. Precise data collection and extraction is vital in accurate generation of trends and reports.

How is the data used?

Once the data is collected and submitted to NCQA, there are different ways the data can be employed. The data is analyzed and trended to create different reports and research based on the HEDIS measures. The reports assist organizations in comparing itself to other organizations. It also allows for different benchmarking at national, regional, and state levels. The different reports generated are:

  • Accreditation Benchmarks and Thresholds Memo – reports national benchmarks and both regional and national thresholds for HEDIS measures and survey results and used to score health plans for accreditation.
  • NCQA’s Health Insurance Plan Ratings – contains results from NCQA-accredited and non-accredited health plans that are based on combined HEDIS/CAHPS and accreditation standards scores.
  • NCQA’s Quality Compass – offers performance data on commercial, Medicaid and Medicare health plans and national, regional, and state benchmarks. The database provides 3 years of performance trend data of HEDIS and CAHPS measures.
  • State of Health Care Quality – an annual report containing national HEDIS and CAHPS scores with performance trends over time.

HEDIS Nurses can help you!

Know that the team at Chart Review Nurses can assist your healthcare plans in collecting and documenting information for your HEDIS measures. HEDIS nurses are specialists in accurate data extraction and reporting for the HEDIS performance tool. Give us a call today at (877) 328-2343 for more information on how we can help you. Improve your healthcare quality services and your HEDIS scores with our experts!