What You Need To Know About The HEDIS Health Care Rating

· Every American needs health insurance – but other than cost, how do they know which one to choose?

· Doctors work alongside health plans – but how do they know more about these companies they are working with?

· And health plans may be experts in their own care and services – but how do they know whether they are better or worse than the next health plan?

The answer to all of these questions is HEDIS, or the Healthcare Effectiveness Data and Information Set. Here’s everything you need to know about this health care rating system.

What Is HEDIS?

HEDIS is a rating system that uses many different specific measures or standards to compare the performance and care of most health plans in the United States. The ratings are performed each year and cover an extremely broad range of issues affecting health plans.

Ideally, it is meant to spur on improvement and positive change in the health care industry, so Americans can be sure to receive the best coverage and care.

What Are The HEDIS Measure?

There are so many HEDIS measures that cover categories such as effectiveness of care, access or availability of care, experience of care, utilization and risk adjusted utilization, resource use, and health plan descriptive information.

Here’s just a very small sample of specific HEDIS measures, so you can see what they’re like:

· Adult BMI Assessment

· Immunizations for Adolescents

· Breast Cancer Screening

· Care for Older Adults

· Medication Management for People With Asthma

· Comprehensive Diabetes Care

· Follow-Up After Emergency Department Visit for Mental Illness

· Adherence to Antipsychotic Medications for Individuals with Schizophrenia

· Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

· Use of Opioids at High Dosage

· Fall Risk Manage

· Annual Dental Visit

· Well-Child Visits in the First 15 Months of Life

· Antibiotic Utilization

· Unhealthy Alcohol Use Screening and Follow-Up

· Race/Ethnicity Diversity of Membership

· Board Certification

For a full list of HEDIS measures, click here.

Who Runs HEDIS? Before you worry that health care plans or doctors could be manipulating the results, rest assured: HEDIS was created and is still maintained by the neutral National Committee for Quality Assurance (NCQA).

Each year the NCQA also reevaluates what measures should be on the HEDIS rating system. They choose these measures based on:

· Relevance (Example: How important is this health care aspect?)

· Scientific Soundness (Example: Can this measure produce similar results from place to place no matter population and setting?)

· Feasibility (Example: Would data collection violate member confidentiality?)

Who Does HEDIS Help? Just about everyone. But to be more specific:

· Health care plan providers/companies

· Doctors and other health care professionals

· People who use health insurance

Which Health Plans Use HEDIS?

Over 90% of the health plans in the United States use the HEDIS rating system.

This means health plans know how they stack up against almost every other health plan in the country and can see where they need improvement. Doctors know exactly which plans they want to partner with. And individuals or families can compare just about every plan in their state to choose the optimal option with confidence.

Where Can I Find HEDIS Rating Results?

All HEDIS ratings from this year – as well as previous years – can be found through the Quality Compass tool on the NCQA website.

Sources: http://www.ncqa.org/hedis-quality-measurement/what-is-hedis http://www.ncqa.org/tabid/414/Default.aspx