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HEDIS®

WHAT IS HEDIS?

HEDIS (Healthcare Effectiveness Data and Information Set) consists of a set of performance measures utilized by more than 90 percent of American health plans that compare how well a plan performs in these areas:

  • Quality of care
  • Access to care
  • Member satisfaction with the health plan and doctors

HEDIS PROVIDER INFORMATION DOCUMENT: Overview of the 2023 NCQA HEDIS measures.

  • The quality measures outlined in the Provider Information Document have a significant role in the health care industry regarding closing gaps in care and decreasing the use of costly acute care through preventive services. By placing a greater focus on value-based care and quality improvement, HEDIS performance measures hold a critical place in helping providers achieve these goals.
  • This document is a resource tool that includes best practices to assist in closing open gaps in care; it is a tool and is not to be used as a substitution to medical decision making.

HEDIS RESULTS: To view Highmark HEDIS 2022 results for measurement year 2021.

 

WHY HEDIS IS IMPORTANT

HEDIS ensures health plans are offering quality preventive care and service to members. It also allows for a true comparison of the performance of health plans by consumers and employers.

 

VALUE OF HEDIS TO YOU, OUR PROVIDERS

HEDIS can help save you time while also potentially reducing health care costs. By proactively managing patients’ care, you are able to effectively monitor their health, prevent further complications and identify issues that may arise with their care.

HEDIS can also help you:

  • Identify noncompliant members to ensure they receive preventive screenings
  • Understand how you compare with other providers as well as with the national average

 

VALUE OF HEDIS TO YOUR PATIENTS, OUR MEMBERS

HEDIS ensures that members will receive optimal preventive and quality care. It gives members the ability to review and compare plans’ scores, helping them to make informed health care choices.

 

WHAT YOU CAN DO

  • Encourage your patients to schedule preventive exams
  • Remind your patients to follow up with ordered tests
  • Complete outreach calls to noncompliant members

If you have questions about HEDIS or need more information, please contact your local Provider Relations representative.

Last updated on 2/23/2023 9:32:32 AM

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

Source: www.ncqa.org
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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.