HEDIS Quality Scores Explained

HEDIS Stands for the Healthcare Effectiveness Data and Information Set. It is Created and by the NCQA, Which is the National Committee on Quality Assurance.

HEDIS and NCQA Measure 412 Medicare Advantage Plans, 171 Medicaid Managed Care Plans and 438 Commercial Insurance Plans.

There are 90 HEDIS Measures Ranging from 1) Mammography Screening Rates to 2) Beta Blocker Usage Rates for Patients with Heart Attacks to 3) Diabetes and Hypertension Outcomes Measures.

HEDIS is a Measure of HEALTH PLAN Quality, Even Though it is the Hospitals, Doctors and Nurses that are Actually Responsible for the Quality.

Therefore, in a Large PPO Network, the Aggregate Health Plan Score May Not Be Helpful Because the Individual Quality of Each Provider Gets Mixed Together.

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