Understanding HEDIS

HEDIS Reporting


Improving healthcare quality

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).  HEDIS was designed to allow consumers to compare health plan performance to other plans. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare Advantage In current usage, the reporting year  after the term is one year following the year reflected in the data; for example, the HEDIS 2009 reports, available in June 2009, contain analyses of data collected from the measurement year January–December 2008

The 90 HEDIS measures are divided into six domains of care

  • Effectiveness of Care

  • Access/Availability of Care

  • Experience of Care

  • Utilization and Relative Resource Use

  • Health Plan Descriptive Information

  • Measures Collected Using Electronic Clinical Data Systems