What is HEDIS?

When you hear the term HEDIS. what do you think it means? Most of us in the healthcare industry know something about HEDIS but are not quite sure what it is. Many think HEDIS is something those folks over in Quality get involved with..that it really has nothing to do with them.  In fact, HEDIS is like an umbrella in the sense it strives to cover, evaluate and improve upon all aspects of a managed healthcare system. 

HEDIS stands for Healthcare Effectiveness Data and Information Set, which is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The performance measures in HEDIS are related to many significant public health care issues including cancer, heart disease, smoking, asthma, childhood immunizations and diabetes. HEDIS also encompasses a standardized survey of consumers' experiences that evaluates plan performance in areas such as customer service, access to care and claims processing.

HEDIS is one of the most widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). NCQA is a not-for-profit organization committed to assessing, reporting on and improving the quality of care provided by organized healthcare delivery systems. However HEDIS has become more than a set of measures; it is part of an integrated system to establish accountability in the health care industry.

We at Horizon view the annual HEDIS evaluation as an opportunity to continually measure, access and improve the delivery of our healthcare products. In future editions of Blue Review, we will focus our discussions of HEDIS to some of its' specific measures. 

Over the next few months, Horizon will be collecting data on randomly selected members for the HEDIS evaluation. You may receive a phone call or fax from a Horizon representative asking your assistance in collecting the necessary information.  Your assistance and prompt response will be greatly appreciated.  

If anyone wishes further information on HEDIS and/or NCQA, you may find it at the NCQA website www.ncqa.org.

Click here to view the HEDIS®  Scores.