Data Sources—National Committee for Quality Assurance (NCQA)

Healthcare Effectiveness Data and Information Set (HEDIS®)

Sponsor

National Committee for Quality Assurance (NCQA).

Description

NCQA developed HEDIS® to provide purchasers and consumers with the information they need to reliably compare the performance of health care plans.

HEDIS is a set of standardized performance measures designed to assess the quality of health care and services provided by managed care plans. The Centers for Medicare & Medicaid Services (CMS) requires health maintenance organizations (HMOs) with 500 or more Federal Employee Health Benefits (FEHB) enrollees to submit HEDIS data.

HEDIS data are collected through surveys, medical charts, and insurance claims for hospitalizations, medical office visits, and procedures. Clinical measures use the administrative or hybrid data collection methodology, as specified by NCQA. Administrative data are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies, and labs. The hybrid method is used when the administration data need to be completed by linking to other data sources.

Primary Content

HEDIS measures are added, deleted, and revised annually. The measures used for the NHQR and NHDR focused on eight areas:

• Effectiveness of care.
• Access/availability of care.
• Satisfaction with the experience of care (member satisfaction).
• Health plan stability.
• Use of services.
• Health plan descriptive information.
• Cost of care.
• Informed health care choices.

Population Targeted

Medicaid, Medicare, and commercial insurance enrollees. The care needs of different populations vary, and health plan systems for managing care may be quite population specific.

Demographic Data

Age, sex, race, and education.

Years Collected

HEDIS versions and names have changed since its initial development:

• Version 1.0, 1991, HMO Employer Data and Information Set.
• Version 2.0, 1993, Health Plan Employer Data and Information Set.
• Version 3.0, 1997, Health Plan Employer Data and Information Set.
• Version 4.0, 2007, Healthcare Effectiveness Data and Information Set.

Schedule

Annual.

Contact Information

Sponsor home page: http://www.ncqa.org.

Data system home page: http://www.ncqa.org/tabid/59/Default.aspx/.