HEDIS
HEDIS stands for Healthcare Effectiveness Data and Information Set (HEDIS). It was developed by the National Committee for Quality Assurance (NCQA) in the 1980s.
CMS uses it now to measure the quality of the work you do.
Primary care providers that ignore this are being penalized in their reimbursements. It is a comprehensive data set developed to provide payors & consumers with the information they need to judge the quality of healthcare providers.
NCQA specifications drive performance standardization to evaluate and compare health plan quality of care.
HEDIS is used to identify improvement opportunities, monitor success quality improvement and set realistic goals.
Your HEDIS (with the addition of CAHPS & HOS) scores form the core of the CMS 5-STAR program. HEDIS & 5-STAR program scores are published publicly. Studies continue to demonstrate that Medicare Advantage programs score higher on all HEDIS scores.
These are some examples of the measures that HEDIS covers:
1.Timbie JW, Bogart A, Damberg CL, Elliott MN, Haas A, Gaillot SJ, Goldstein EH, Paddock SM. Medicare Advantage and Fee-for-Service Performance on Clinical Quality and Patient Experience Measures: Comparisons from Three Large States. Health Serv Res. 2017 Dec;52(6):2038-2060. doi: 10.1111/1475-6773.12787. PMID: 29130269; PMCID: PMC5682140https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682140/
2. King, R. Medicare Advantage plans achieve better outcomes than traditional Medicare, BMA analysis finds. Fierce Healthcare Dec, 2020.
3. Ayanian, J. Z. , Landon B. E., Zaslavsky A. M., Saunders R. C., Pawlson L. G., and Newhouse J. P.. 2013. "Medicare Beneficiaries More Likely to Receive Appropriate Ambulatory Services in HMOs Than in Traditional Medicare." Health Affairs (Millwood) 32 (7): 1228–35.
4. Elliott, M. N. , Landon B. E., Zaslavsky A. M., Edwards C., Orr N., Beckett M. K., Mallett J., and Cleary P. D.. 2016. "Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts." Health Affairs (Millwood) 35 (3): 456–63.
5. Gold, M. , and Casillas G.. 2014. "What Do We Know about Health Care Access and Quality in Medicare Advantage Versus the Traditional Medicare Program?" https://www.kff.org/medicare/report/what-do-we-know-about-health-care-access-and-quality-in-medicare-advantage-versus-the-traditional-medicare-program/
6. Keenan, P. S. , Elliott M. N., Cleary P. D., Zaslavsky A. M., and Landon B. E.. 2009. "Quality Assessments by Sick and Healthy Beneficiaries in Traditional Medicare and Medicare Managed Care."
7. Landon, B. E. , Zaslavsky A. M., Bernard S. L., Cioffi M. J., and Cleary P. D.. 2004. "Comparison of Performance of Traditional Medicare vs Medicare Managed Care." Journal of the American Medical Association 291 (14): 1744–52.
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