The acronym HEDIS stands for Healthcare Effectiveness Data and Information Set and according to the National Committee for Quality Assurance (NCQA), is the most widely used set of performance measures in the managed care industry. HEDIS is a tool consisting of over 90 measurements utilized to compare health plan quality across the nation and is a requirement to be an accredited health plan. The accreditation seal assures members/patients that they are being cared for by both a quality health plan and quality providers.
Providers are vital to helping maintain accreditation status and ensuring quality care is delivered. By educating patients on the importance of cancer screenings, managing chronic conditions, addressing behavioral health matters, etc. providers are directly impacting the HEDIS rates.
Below are several resources to assist with the application of HEDIS metrics and gap closures. The UnitedHealthcare Quality Reference Guide is a detailed overview of the HEDIS measures with measure descriptions and details, coding recommendations and actionable takeaways. The Provider Resource Guide is a 1-page snapshot of key measures and actions. The Coding Tool offers guidance on NCQA approved codes that can be used to close HEDIS gaps in care, and the Lunch & Learn Series consists of presentations created by registered nurses on various HEDIS topics. These materials are updated annually or as changes are implemented.
Health plans conduct a member satisfaction survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). CAHPS is a member survey that gauges satisfaction with services provided by the health plan as well as member perception of provider accessibility, the patient-physician relationship and provider communication. This survey is conducted annually and results are then compared with national benchmarks.
For further information on HEDIS, please see the details in the UHC Quality Reference Guide or feel free to reach out to the Clinical Quality team at ClinicalQualityNV@uhc.com.