The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used sets of health care SHOULD BE ONE WORD performance measure in the United States. The NCQA measurement development process has expanded the size and scope of HEDIS to include measures for physicians, Preferred Provider Organizations (PPO) and other Health Maintenance Organizations (HMO). The HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. NCQA collects HEDIS data directly from Health Plan Organizations and Preferred Provider Organizations for multiple purposes via the Healthcare Organization Questionnaire (HOQ) and HEDIS non-survey data through the Interactive Data Submission System (IDSS). National Committee for Quality Assurance (NCQA) collects Medicare HEDIS data on behalf of the Centers for Medicare & Medicaid Services (CMS), and Medicaid HEDIS data on behalf of state agencies. In addition, NCQA collects commercial data on behalf of some states and the U.S. Office of Personnel Management for health plan report cards.
The National Committee for Quality Assurance (NCQA) is an independent non-profit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. NCQA operates on a formula of measure, analyze, and improve and it aims to build consensus across the industry by working with policymakers, employers, doctors, and patients, as well as health plans. Health plans seek accreditation and measure performance through the administration and submission of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
HEDIS data collected by NCQA are important for researchers working to improve the health care system, as well as for NCQA staff seeking to improve the HEDIS measures themselves. Commercial HEDIS data are used to calculate national performance statistics and benchmarks, as well as to set standards for measures included in NCQA’s Accreditation program. Developing a measure is a multi-step process. It involves identifying the clinical area to evaluate; conducting an extensive literature review; developing the measure with the appropriate MAP and other panels; vetting it with various stakeholders; and performing a field-test that looks at feasibility, reliability and validity. NCQA consistently raises the bar. Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA’s seal of approval. These standards will promote the adoption of strategies that will improve care, enhance service and reduce costs, such as paying providers based on performance, leveraging the Web to give consumers more information, disease management and physician-level measurement. Many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans.