HEDIS Background
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90% of America's health plans to measure performance on important dimensions of care and service. The National Committee for Quality Assurance (NCQA) collects HEDIS survey results directly from health plans and Preferred Provider Organizations (PPOs) through the Healthcare Organization Questionnaire (HOQ) and gathers HEDIS non-survey data through the Interactive Data Submission System (IDSS).
HEDIS consists of 81 measures across five domains of care. Because so many plans collect HEDIS data, and since the measures are specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis.
Succeeding with HealthEC
HealthEC supports quality improvement efforts and streamlines performance data submissions for payers by:
- Providing physician dashboards with drill-down capabilities to highlight and help resolve variances in compliance with the measures
- Supporting automated closures of gaps in care that require clinical, lab and prescription data
- Ensuring provider data compliance monitoring and submission that complies with the annual changes in measurement sets
- Validating HEDIS and eCQM measures data on behalf of payers
HealthEC provides a robust solution to help navigate challenges associated with HEDIS reporting including:
- Seamless integration of claims, clinical, prescription, and lab data
- Calculation of financial rewards for quality and other pay-for-performance metrics
- Support for compliance with HEDIS benchmarks and internally set goals
- Dashboards and reports measured by practice and provider
- HEDIS measure calculation at the organization, practice, and provider level
HealthEC can submit HEDIS measures to insurance companies on behalf of our provider clients and can also validate HEDIS data for payers, eliminating up to 50% of data confirmation cost. In addition, HealthEC has received certification for multiple eCQMs and supports the use of eCQMs to ensure data reporting integrity.