What is HEDIS® . . .

    Posted by Quartz on December 26, 2017

    . . . and Why Is It Important?

    HEDIS®HEDIS® stands for Healthcare Effectiveness Data and Information Set. It is a measurement tool used by more than 90 percent of U.S. health plans to evaluate performance in clinical quality and customer service.

    HEDIS looks at several different areas of care, known as measures. The measures are the same for each health plan so that they can be easily compared. Some HEDIS measures focus on prevention. Examples are flu shot, breast cancer screening or other cancer screenings.

    Other measures look at how well people with ongoing health problems are cared for. For example, members who have diabetes need blood sugar tests, eye exams, blood pressure checks and other care. Some of these measures use information from the claims sent by your doctor; other measures use information gathered by reviewing medical charts. HEDIS also uses information from other sources, such as the Wisconsin Immunization Registry. Many health plans, such as Quartz-branded Unity Health Plans Insurance Corporation (Unity), use HEDIS results to make improvements in their quality of care and service.

    In 2016, Unity was in the top 5 percent of managed care organizations in the nation for
    the following measures –

    • Childhood Immunizations: DTaP, Hepatitis B, Influenza vaccine
    • Adolescent Immunizations: Tdap, Human Papillomavirus Vaccine
    • Breast Cancer Screening
    • Colorectal Cancer Screening
    • Use of Spirometry Testing in Assessment and Diagnosis of COPD
    • Diabetes Care: Blood Pressure in Good Control (under 140 / 90)
    • Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
    • Follow-up after Hospitalization for Mental Illness (within 30 days)
    • Prenatal Care
    • Postpartum Care
    • Use of First-Line Psychosocial Care for Children and Adolescents, 12-17 year olds

    In 2016, Unity was in the top 10 percent of the managed care organizations in the nation
    for the following measures -

    • Adult BMI Assessment
    • Childhood Immunizations: MMR, Pneumococcal
    • Cervical Cancer Screening
    • Asthma Medication Ratio
    • Controlling High Blood Pressure
    • Statin Therapy for Patients with Cardiovascular Disease – Received Statin Therapy
    • Diabetes Care, Hemoglobin A1C (HbA1c) Testing and HbA1c Control (under 8%)
    • Statin Therapy for Patients with Diabetes – Received Statin Therapy
    • Follow-up after Hospitalization for Mental Illness: 7 days
    • Non-recommended Cervical Cancer Screening in Adolescent Females
    • Use of First-Line Psychosocial Care for Children and Adolescents, Total

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

    Topics: Member Newsletter

    Note - This is a public blog forum. If you have specific questions about your benefits, please contact Quartz Customer Service at 800.362.3310 or send us a secure email.

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