What is HEDIS?

The National Committee for Quality Assurance (NCQA) developed HEDIS (Health Effectiveness Data and Information Set) with input from hundreds of organizations representing every sector in the nation’s health care industry. HEDIS is a broad set of performance measures that provide purchasers and consumers with data relating to the quality of health care.

HEDIS reporting enables Horizon Blue Cross Blue Shield of NJ (BCBSNJ) to trend data and develop new programs and initiatives accordingly to help improve the health status of our members. Increases in HEDIS scores over the years demonstrate Horizon BCBSNJ’s commitment to quality improvement and performance measurement.

HEDIS includes 70 measures in 7 domains of care:

• Effectiveness of Care
• Access/Availability of Care
• Satisfaction with the Experience of Care
• Use of Services
• Cost of Care
• Health Plan Descriptive Information
• Health Plan Stability

Effectiveness of Care measures provide details about the quality of clinical health care delivered to members. The measures analyze how well Horizon BCBSNJ participating physicians follow widely accepted preventive practices and encourage recommended screenings. Breast cancer screening, childhood immunization status, persistence of beta-blocker treatment after a heart attack and antidepressant medication management are a few examples of effectiveness of care measures.

Access and Availability of Care measures include visits to primary care physicians, initiation and engagement of alcohol and other drug dependence treatment, prenatal/postpartum care and member call statistics for the plan.

Satisfaction with the Experience of Care includes a survey to members addressing getting needed care, getting care quickly, communication with physicians, customer service and claims processing.

Use of Services provides data on well child care, frequency of selected procedures, inpatient utilization, outpatient drug utilization and mental health utilization.

Cost of Care, Health Plan Descriptive Information and Health Plan Stability domains supply consumers with further information about health care quality and Horizon BCBSNJ.

Click here to view the HEDIS^® Summary.