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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.
Health plans seek accreditation and measure performance through the administration and submission of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The National Committee for Quality Assurance provides an evidence-based program for case-management ...
[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]
For example, for diabetes, HEDIS selects an eligible population based on age (18–75 years), continuous enrollment with a certain health insurer and certain "Events/diagnosis" from pharmacy data (electronic), insurance claims data (electronic) or from medical records. Pharmacy data is based on a list of medications prescribed for diabetes.
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]
In October 2020, the company received a validation status of "Validated with Exception" for the Data Validation (DAV) [8] Program from the National Committee for Quality Assurance . [9] "Validated with Exception" indicates that the HIE can share validated sources for standard supplemental data for use in measurement year 2020 HEDIS reporting. [10]
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]
The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes and non-critical access hospitals with Medicare swing bed agreements.