What Are the HEDIS Quality Measures?

What Are the HEDIS Quality Measures?

Every year, the National Committee for Quality Assurance (NCQA) puts out a list of HEDIS Quality Measures that health plans are rated on. This list of 90 some measures stretches out across various domains of care.

What are the 6 domains of care for HEDIS measures?

There are 6 domains of care that each HEDIS quality measure falls under. These domains of care are:

  • Effectiveness of Care
  • Access/Availability of Care
  • Experience of Care
  • Utilization and Risk-Adjusted Utilization
  • Health Plan Descriptive Information
  • Measures Collected Using Electronic Clinical Data Systems

What are the specific HEIDS measures in each domain of care?

Did you know that there are over 90 HEDIS quality measures that fall under the six domains of care? These specific HEDIS measures include:

Effectiveness of Care

  • Prevention and Screening
  • Respiratory Conditions
  • Cardiovascular Conditions
  • Diabetes
  • Musculoskeletal Conditions
  • Behavioral Health
  • Medication Management and Care Coordination
  • Overuse/Appropriateness
  • Measures Collected Through the Medicare Health Outcomes Survey
  • Measures Collected Through the CAHPS® Health Plan Survey

Access/Availability of Care

  • Adults’ Access to Preventive/Ambulatory Health Services
  • Children and Adolescents’ Access to Primary Care Practitioners
  • Annual Dental Visit
  • Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment
  • Prenatal and Postpartum Care
  • Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics

Utilization and Risk-Adjusted Utilization

  • Child and Adolescent Well-Care Visits
  • Frequency of Selected Procedures
  • Identification of Alcohol and Other Drug Services
  • Mental Health Utilization
  • Antibiotic Utilization
  • HAI Standard Infection Ratio
  • Plan All-Cause Readmissions
  • Acute Hospital Utilization
  • Emergency Department Utilization
  • Hospitalization for Potentially Preventable Complications

Measures Collected Using Electronic Clinical Data Systems

  • Depression Screening and Follow-Up for Adolescents and Adults
  • Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
  • Depression Remission or Response for Adolescents and Adults
  • Unhealthy Alcohol Use Screening and Follow-Up
  • Pneumococcal Vaccination Coverage for Older Adults

If you need help with your HEDIS projects, contact HEDIS Nurses for assistance!

At HEDIS Nurses, we know the ins and outs of all things HEDIS. The NCQA updates the HEDIS quality measures every year so while this list might seem daunting, imagine trying to learn a new one in just six short months! The great thing about HEDIS Nurses is that we keep up with all of that for you. We offer assistance with all things HEDIS from chart abstractions to full outsourcing of your HEDIS projects.

Our skilled team is highly qualified and well versed in HEDIS requirements and quality measures. Backed by the Datafied name, that means you can trust us to do a quality and timely job. If you are interested in improving your risk adjustment coding, give us a call at (877) 328-2343 today to obtain a quote and start the process.

To learn more about the reliable and quality HCC coding services that we offer, visit us on the web at HCC coding.