Healthcare Effectiveness Data and Information Set

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. Although not originally intended for trending, HEDIS results are increasingly used to track year-to-year performance. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare Advantage.

HEDIS was originally titled the "HMO Employer Data and Information Set" as of version 1.0 of 1991. In 1993, Version 2.0 of HEDIS was known as the "Health Plan Employer Data and Information Set". Version 3.0 of HEDIS was released in 1997. In July 2007, NCQA announced that the meaning of "HEDIS" would be changed to "Healthcare Effectiveness Data and Information Set."

In current usage, the "reporting year" after the term "HEDIS" is one year following the year reflected in the data; for example, the "HEDIS 2009" reports, available in June 2009, contain analyses of data collected from "measurement year" January–December 2008.

The 83 HEDIS measures are divided into five "domains of care":

The 2016 specification is available here.

Measures are added, deleted, and revised annually. For example, a measure for the length of stay after giving birth was deleted after legislation mandating minimum length of stay rendered this measure nearly useless. Increased attention to medical care for seniors prompted the addition of measures related to glaucoma screening and osteoporosis treatment for older adults. Other health care concerns covered by HEDIS are immunizations, cancer screenings, treatment after heart attacks, diabetes, asthma, flu shots, access to services, dental care, alcohol and drug dependence treatment, timeliness of handling phone calls, prenatal and postpartum care, mental health care, well-care or preventive visits, inpatient utilization, drug utilization, and distribution of members by age, sex, and product lines.

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