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Healthcare Effectiveness Data Paper

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The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of performance measures used to track the quality of healthcare. HEDIS was developed by the National Committee for Quality Assurance (NCQA) to allow consumers to compare managed care organizations (MCOs). According to NCQA, HEDIS allows consumers to compare healthcare plans as “apples to apples”, in other words HEDIS organizes data for equitable comparison.
HEDIS collects data in five different areas including:
1. Effectiveness of Care
2. Access/Availability of Care
3. Experience of Care (Patient Satisfaction)
4. Utilization and Relative Resource Use
5. Health Plan Descriptive Information (Kohler, 2014).
Why is collecting information in these particular areas so important? First and foremost, the data collected is a valuable resource for consumers. HEDIS publishes the State of Quality Healthcare Report annually, and HEDIS report cards grade MCOs on their overall performance. Consumers can also use HEDIS’s Quality Compass to easily compare healthcare plans based on their needs. HEDIS performance measures allow MCOs to determine their effectiveness at any given time. If any changes are detected, MCOs may want to enact quality improvement measures to improve outcomes. Furthermore, MCOs can use HEDIS data …show more content…
For example, an MCO decided to focus their resources on improving the rate of retinal eye exams for their members with diabetes. Using HEDIS performance measures, and HEDIS reporting data the MCO was able to improve their screening rate from 59.4%, to 69.6% over a three-year period (NCQA, n.d.). HEDIS performance measures also encourage some MCOs to achieve patient outcome rates above and beyond the current HEDIS measures. Another MCO decided to allocate additional resources to diabetes education and management among plan members. As a result, the MCO experienced

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