Use of HEDIS Measures

Use of HEDIS Measures

The Healthcare Effectiveness Data and Information Set (HEDIS) measures focuses on 6 domains of care and is one of the mostly used performance improvement tools. The HEDIS measure is managed by the National Committee for Quality Assurance (NCQA), which is an organization with a goal of improving the quality of health care. There are various institutions that utilize the HEDIS measures to evaluate themselves. The NCQA supports the use of the HEDIS measure specifications to evaluate and drive the quality of health care. It is important that the HEDIS measure specification results are appropriately calculated to ensure that they are accurate. To use the HEDIS measures, ensure that the appropriate license agreements and tools are applied. NCQA works with health care organizations, vendors and consultants, and public stakeholders who want to incorporate HEDIS measure specifications into their products, and programs or services. The proper license agreements with NCQA will allow and address the intended use of the HEDIS measure specifications. This may include the use and compliance with the rules for allowable adjustments and the completion of NCQA’s measure certification program.

Health Care Organizations

Health Care Organizations can use the HEDIS measure specifications for internal and noncommercial purposes, such as for internal quality improvement activities. This can be accomplished by purchasing the appropriate user-level license to the HEDIS Volume 2. For internal, noncommercial use of the HEDIS measure specifications, the NCQA measure certification is not a requirement. If certain HEDIS results are desired to be publicized by the health care organization, then appropriate disclaimers must be included per the HEDIS Volume 2 agreement.

Vendors and Consultants

Vendors and consultants who want to use the HEDIS measure specifications for commercial purposes or any external reproduction, distribution or publication, then a commercial use license must be obtained. Commercial purposes include offering products or services for closing medical care gaps to improve health activities or calculating measure rates for submission to external programs. If a vendor or consultant uses internal measure logic, it will have to be validated by NCQA’s measure certification program.

Public Sector Stakeholders

The NCQA supports public sector stakeholders, such as the federal and state entities, to use the HEDIS measure specifications in their programs with appropriate licenses. These public sector entities that use a third party to calculate HEDIS measure rates may be required to use an NCQA certified vendor or have their selected vendor achieve the NCQA measure certification.

We can help you!

If you would like to know how you can use HEDIS measures with your institution, let us know. Give Hedis Nurses a call at (877) 328-2343 to see how we can help!