Individuals. Families. Doctors. Insurance companies. Many different people are interested in the quality of America’s health care plans. The Healthcare Effectiveness Data and Information Set (HEDIS) gives you the answers you are seeking.

  • How good are different plans in providing preventative care?
  • What about treatment options?
  • And how many do it so well that customers feel satisfied about their overall experience?
  • Do these plans offer great physician and hospital choices?

What Is HEDIS?

HEDIS is a tool for better understanding health care plans. Created by the National Committee for Quality Assurance (NCQA), HEDIS has a standardized set of performance measures that show the different health plans’ levels of service and care toward members.

There are 81 performance measures broken down into 5 large care domains. Here are some examples of HEDIS measures. As you can see, they cover a large variety of some of the most important health issues facing Americans – men and women, young and old:

  • Asthma Medication Use
  • Persistence of Beta-Blocker Treatment after a Heart Attack
  • Controlling High Blood Pressure
  • Comprehensive Diabetes Care
  • Breast Cancer Screening
  • Medical Assistance With Smoking and Tobacco Use Cessation
  • Annual Monitoring for Patients on Persistent Medications
  • Antidepressant Medication Management
  • Childhood and Adolescent Immunization Status
  • Childhood and Adult Weight/BMI Assessment
  • Follow-Up Care for Children Prescribed ADHD Medication
  • Well-Child Visits
  • Prenatal and Postpartum Care

Since over 90% of health plans in America use HEDIS, it is easier to have an “apples to apples” (as the NCQU likes to describe it) comparison of all the health plan options. You can have a realistic and comprehensive look at health care in the United States.

Plus, these measures evolve throughout the years to ensure updated, accurate information for changing times.

Also, any health plan that wants to offer their services to anybody on Medicare/Medicaid, must submit their HEDIS data. This should give anybody on Medicare the confidence of being able to see how the plan does compared to private choices.

Who Benefits From HEDIS?

This tool that can be used by many different people with many different goals in mind:

  • Individuals and families have can make informed decisions about the health plans they have to choose from. The results each year can be easily found through the State of Health Care Quality report as well as the online Quality Compass, which allows you to compare various plans.
  • Health care professionals have a clearer look at the insurance companies they are continually working with.
  • The health plan providers themselves are able to see how they stack up against other choices – the competitive nature of this comparison can lead to improved plans for all Americans. It also gives health care plan companies a benchmark to see how well they do from year to year.

As you can see, being aware of HEDIS is important for anybody in or benefiting from health care.