Healthcare Data: An Analysis of the HEDIS Effectiveness Report

This presentation provides an overview of the Healthcare Effectiveness Data and Information Set (HEDIS), a widely used tool for measuring the performance of healthcare plans. It highlights that HEDIS is used to measure 90% of America’s all health plans and has been in effect since 1991. The National Committee for Quality Assurance (NCQA), a non-profit organization, sponsors the HEDIS report card, which is intended for buyers and consumers of healthcare plans. The presentation explains that HEDIS aims to measure and compare care and service performances of healthcare plans, collecting data through surveys and the Interactive Data Submission System (IDSS). It also discusses the strengths of HEDIS, such as its rigorous selection process and usefulness for evaluating healthcare plans, as well as its weaknesses, including its failure to account for specific population risks and potential conflicts of interest. The presentation further details the data collection methods, data accuracy, frequency of report publication, and ease of access to HEDIS data.

Healthcare Effectiveness Data
and Information Set (HEDIS)
Name of the Student

• HEDIS – Use to measure 90 % of America’s all
health plans.
• In effect from - 1991
• Sponsor of HEDIS report card - National
Committee for Quality Assurance (NCQA), a non
profit organization of USA.
• Intended audience of the report card – Buyers and
consumers of healthcare plans (HEDIS - NCQA,
2018).
HEDIS

• Objective – measure and compare care and service
performances of healthcare plans.
• Data collection method – NCQA collects survey data directly
from healthcare plans and PPOs.
• Non-survey data are collected through Interactive Data
Submission System (IDSS)
• All collected data by NCQA are maintained in a secure central
database (HEDIS - NCQA, 2018).
HEDIS

HEDIS
Strengths Weaknesses
• Undergoes rigorous selection
process such as feasibility and
scientific credibility
• Data collected from HEDIS are
useful for evaluation of healthcare
plans.
• It is widely recognised, accepted
and used.
• HEDIS data allows drafting of
better and cost effective plans
• Does not accounts for specific
risk for a particular population
• HEDIS data might encourage the
prescription of more controller
medication for asthma (Berger
et al., 2004)
• Might be conflict of interest as
NCQA works closely with health
care industry.

HEDIS
• Source of DATA collection – Surveys, medical charts, and insurance
claims
• Data accuracy – All data are audited by NCQA approved auditing firm.
• Frequency of report publication – Annually
• Quality compass – an annually published report provides quality
benchmark on different healthcare plan (Kapp, 2002).
• Ease of access – concise information in organised manner in a single
place helps construction of better plan as well as it helps to consumer
and buyers of health care plans (HEDIS Reporting | Facts About HEDIS
Reporting & Measurements, 2018)

References
• Berger, W. E., Legorreta, A. P., Blaiss, M. S., Schneider, E. C., Luskin, A. T., Stempel, D. A., ... &
Sullivan, S. D. (2004). The utility of the Health Plan Employer Data and Information Set (HEDIS)
asthma measure to predict asthma-related outcomes. Annals of Allergy, Asthma &
Immunology, 93(6), 538-545.
• HEDIS - NCQA. (2018). Retrieved from https://www.ncqa.org/hedis/
• HEDIS Reporting | Facts About HEDIS Reporting & Measurements. (2018). Retrieved from
https://frgsystems.com/healthcare-finance-news/facts-about-hedis-reporting
• Kapp, M. C. (2002). Provider-and plan-specific measures of quality. Health care financing review, 23(4), 1.