HEDIS 2017 Measures

HEDIS 2017 is coming. HEDIS (The Healthcare Effectiveness Data and Information Set) is a set of standardized measures specifying how health care plans collect, audit and report performance information in specific clinical areas, customer satisfaction, and patient experience. HEDIS data is collected through chart reviews, medical claims and surveys as well as some self-reporting by health plans. Medicare (MCR), Medicaid (MCD) and commercial insurance plans (COMM) use HEDIS as a comparison tool between health care providers. This comparison is ultimately presented to the public as a Five Star Rating system. Incentives and prestige increase as Star scores increase. Low performing plans may find themselves in jeopardy of losing their Medicare and Medicaid contracts.

HEDIS is maintained by the National Committee for Quality Assurance (NCQA).  Measures reported by survey through Health Outcome Surveys (HOS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) must be conducted by an NCQA approved survey organization. These surveys will be discussed separately in another article. 

For HEDIS 2017, there are now 91 measures across 7 domains of care:

1.   Effectiveness of Care

Prevention and Screening

• Adult BMI Assessment (ABA) – MCR, MCD, COMM
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children/

Adolescents (WCC) -  MCD, COMM

• Childhood Immunizations Status (CIS) – MCD, COMM
• Immunizations for Adolescents (IMA) – MCD, COMM
• Lead Screening in Children (LSC) - MCD
• Breast Cancer Screening (BCS) – MCR, MCD, COMM
• Colorectal Cancer Screening (COL) – MCR, COMM
• Care of Older Adults (COA) – MCR

Respiratory Conditions

• Appropriate Testing for Children with Pharyngitis (CWP) – MCD, COMM
• Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) – MCR, MCD, COMM
• Pharmacotherapy Management of COPD Exacerbation (PCE) – MCR, MCD, COMM
• Medication Management for People with Asthma (MMA) – MCR, MCD, COMM
• Asthma Medication Ratio (AMR) – MCD, MCR, COMM

Cardiovascular Conditions

• Controlling High Blood Pressure (CBP) – MCR, MCD, COMM
• Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) – MCR, MCD, COMM
• Statin Therapy for Patients with Cardiovascular Disease (SPC) – MCR, MCR, COMM

Diabetes

• Comprehensive Diabetes Care (CDC) – MCR, MCD, COMM
• Statin Therapy for Patients with Diabetes (SPD) – MCR, MCD, COMM

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