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