Full Answer
Why do so many health plans use HEDIS?
Because so many health plans use HEDIS and because the measures are so specifically defined, HEDIS can be used to make comparisons among plans. To ensure that HEDIS stays current, the National Committee for Quality Assurance (NCQA) has established a process to evolve the measurement set each year through its Committee on Performance Measurement.
What is HEDIS abstraction?
Abstraction of administrative claims data or data from other records. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care and service.
What are the different types of HEDIS measures?
HEDIS Measures 1 Effectiveness of Care 2 Access/Availability of Care 3 Utilization 4 Risk Adjusted Utilization 5 Measures Reported Using Electronic Clinical Data Systems. HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and ...
What are the rules for allowable adjustment of HEDIS?
Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives.
How is asthma medication ratio calculated?
Asthma Medication Ratio (AMR) Calculation: Thus, the AMR is 2 / (2+6) = 0.25. Intent / Importance: Medications for asthma are usually categorized into long-term controller medications used to achieve and maintain control of persistent asthma and quick-reliever medications used to treat acute symptoms and exacerbations.
What are the 2021 HEDIS measures?
HEDIS MY 2020 & MY 2021 Draft FHIR Digital Measures (5 Measures)Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)Cervical Cancer Screening (CCS)Childhood Immunization Status (CIS)Immunizations for Adolescents (IMA)Non-Recommended PSA-Based Screening in Older Men (PSA)
What are HEDIS administrative measures?
Administrative only measures calculated using administrative data include: annual mammogram, annual Chlamydia screening, treatment of pharyngitis, treatment of URI, appropriate treatment of asthma, antidepressant medication management, annual dental care, access to PCP services, and utilization of acute and mental ...
What are HEDIS codes?
CPT: 99483, 99497. CPT-CAT-II: 1123F, 1124F, 1157F, 1158F.HCPCS: S0257. ICD-10: Z66.(Medication Review) CPT: 90863, 99605, 99606, 99483.CPT-CAT-II: 1159F, 1160F. HCPCS: G8427.Functional Status Assessment. CPT: 99483.CPT-CAT-II: 1170F. HCPCS: G0438, G0439.Pain Assessment. CPT-CAT-II: 1125F, 1126F.
What are examples of HEDIS measures?
Examples of HEDIS® measures are Comprehensive Diabetes Care, Childhood Immunizations, yearly Well Child Exams for Children Ages 3-6 and yearly Adolescent Well Care Exams.
What are the 81 HEDIS measures?
HEDIS MeasuresEffectiveness of Care.Access/Availability of Care.Experience of Care.Utilization and Risk Adjusted Utilization.Health Plan Descriptive Information.Measures Reported Using Electronic Clinical Data Systems.
What are the 5 domains of care for HEDIS?
HEDIS measures clinical quality and customer service, requiring standardized reporting under 5 domains of care:Effectiveness of Care.Access/Availability of Care.Experience of Care.Utilization and Risk Adjusted Utilization.Health Plan Descriptive Information.Measures collected using Electronic clinical data Systems.
What are the 2020 HEDIS measures?
HEDIS measures address a range of health issues including: asthma medication use; persistence of beta-blocker treatment after a heart attack; controlling high blood pressure; comprehensive diabetes care; breast cancer screening; antidepressant medication management; immunization status; and advising smokers to quit.
What are the 2022 HEDIS measures?
Race/Ethnicity Stratification HEDIS 2022 adds this stratification to the following measures: Colorectal Cancer Screening, Controlling High Blood Pressure, Hemoglobin A1c Control for Patients with Diabetes, and Prenatal and Postpartum Care. These measures currently show in Evoke360.
What is HEDIS chart Chase?
There is a better way than chart chasing Currently, HEDIS® consists of 94 measures across seven domains of care. Measures are tied to a person's age, gender and health status, and each has specific documentation requirements.
What is HEDIS chart review?
A HEDIS chart review is when the National Committee for Quality Assurance (NCQA) reviews a patient's medical records to determine if the quality of care measures have been met. Medical chart reviews are also the data source used by the NCQA to determine any incentives or financial rewards for health plans.
How are HEDIS measures collected?
HEDIS data is collected through a combination of surveys, medical record audits, and claims data. The data collected provides information regarding customer satisfaction, specific health care measures, and structural components that ensure quality of care.
What is HEDIS in healthcare?
HEDIS is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. SNPs can use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards that allow comparison with other plans. Data allow identification of performance gaps and establishment of realistic targets for improvement.
What is HEDIS measurement?
HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. SNPs can use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards ...
Abbreviations used
What is already known about this topic? Administrative data–based measures are being increasingly used to assess asthma quality of care. The Asthma Medication Ratio has been previously validated and shown to correlate with improved asthma outcomes.
Methods
This study was approved by the Kaiser Permanente Southern California Institutional Review Board.
Results
A total of 30,040 patients who met HEDIS criteria for persistent asthma at the end of 2012 were identified from the Kaiser Permanente Southern California database and tracked for asthma outcomes in the year 2013.
Discussion
Publicly reported administrative data-based measures such as the HEDIS asthma measures are widely used to compare and rate health care organizations in terms of quality of care, so it is important that these measures be related to improved health outcomes.
Measure Exclusions
Required Exclusions: Any of the below anytime during a member’s history through Dec. 31 of the measurement year:
Measure Medications
Log in to your HealthLINK account to view information on your EHP/Priority Partners/Advantage MD patients.
What is HEDIS survey?
HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS ®) program.
What is a VSD in HEDIS?
The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. NCQA’s HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications.
What is CAHPS trademark?
CAHPS ® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
