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The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure ...
These consensus standards are largely concerned with measuring and publicly reporting on performance in healthcare settings. NQF uses a multi-step consensus development process to vet performance measures created by public and private measure developers including the NCQA, CMS, and Physician Consortium for Performance Improvement (PCPI). [8]
Most frequently, a list of patients with a certain condition (e.g. diabetes) is generated based on certain criteria. In the U.S., Healthcare Effectiveness Data and Information Set (HEDIS) criteria are set annually by the National Committee for Quality Assurance (NCQA). These criteria, in order to avoid paper charts reviews are in most cases ...
[4]: 19 Accreditation by the NCQA is often expected or require by employers. [4]: 19 The Healthcare Effectiveness Data and Information Set (HEDIS) is a prominent set of measurements and reporting on it is often mandated by states as well as Medicare; [4]: 19 as of 2017, HEDIS data was collected for plans covering 81% of the insured. [42]
In 2015 CMS identified 254 quality measures for which providers may choose to submit data. The measures map to U.S. National Quality Standard (NQS) health care quality domains: [4] Communication and Care Coordination; Community/Population Health; Effective Clinical Care; Efficiency and Cost Reduction; Patient Safety
In 1965, CHAP was the first to recognize the need and value for accreditation in community-based care. The organization was created as a joint venture between the American Public Health Association and the National League for Nursing (NLN). CHAP became a separately incorporated, non-profit subsidiary of the NLN in 1988, under the CHAP name.
During her tenure, NCQA developed, maintained and expanded the Healthcare Effectiveness Data and Information Set (HEDIS), the nation's most-widely used quality measurement tool. [6] NCQA has grown to plus $60 million company with over 300 employees and is the main accreditor of recognized medical homes [7]