What is HEDIS?
HEDIS is the acronym for the Healthcare Effectiveness Data and Information Set.
• It is a tool used by the health plans to measure performance on important aspects of care and service.
• The program was developed and maintained by the National Committee for Quality Assurance (NCQA).
• HEDIS is measured annually and the score is published the following year.
• Claims and encounter data is used to meet administrative HEDIS measures.
Why Is HEDIS Important?
• Emphasizes preventive care and disease management.
• HEDIS scores are often tied in with P4P (Pay for Performance) programs that allow incentives to be earned by providers and IPA/Medical Groups
• Supports delivery of quality care to members.