Healthcare Effectiveness Data and Information Set (HEDIS)
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 is used by more than 90 percent of America's health plans and allows consumers to compare health plan performance to other plans and to national or regional benchmarks.
How Does the Program Work?
- Measurement results are obtained annually from member medical record data and submitted claims, and are validated by an independent auditor.
- A random selection process of members is drawn based on criteria from the NCQA.
- This annual review process is digital to enhance security and efficiency and creates digital copies of medical records during onsite reviews.
- Although HEDIS measurements require the review of member-specific information, Wellmark only reports aggregate data.
The data collected in HEDIS provides physicians and Wellmark a snapshot of areas where we meet or exceed quality care measures and where we need to work together to improve health care in Iowa. HEDIS results are published across a number of volumes and include 80 measures across five domains of care:
- Effectiveness of care
- Access/availability of care
- Satisfaction with the experience of care
- Use of services
- Health plan descriptive information
Wellmark values HEDIS data because:
- It is part of the NCQA Accreditation Process.
- Annual HEDIS rates determine accreditation status.
- It serves as a quality of care indicator for health care and service.
- It provides a reputable benchmarking and performance measurement system for plan comparison.
The results of HEDIS allow Wellmark to develop and implement focused interventions to impact member health. Provider cooperation during data collection periods is appreciated.