Healthcare Effectiveness Data and Information Set (HEDIS)

The Healthcare Effectiveness Data and Information Set, more commonly called HEDIS, consists of compiled reports from managed-care organizations concerning their health plan performance on a broad range of clinical and nonclinical measures. The National Committee for Quality Assurance (NCQA) developed and released the initial version of the measures in 1993. Although most participation in HEDIS is voluntary, more than 90% of U.S. health plans submit HEDIS data, in part to increase their competitiveness but [Page 460]also, often, as part of accreditation or certification activities. Health services researchers also use HEDIS measures to conduct studies of the access, cost, quality, and outcome of care.

HEDIS measures are divided into eight categories: (1) effectiveness of care, (2) access to and availability of care, (3) satisfaction with the experience of care, (4) use of services, (5) cost of care, (6) health plan descriptive information, (7) health plan stability, and (8) informed-care choices. Of these, effectiveness of care is the largest category and includes measures dealing with highly specific standards of care such as appropriate medication for asthma patients and the use of medical-imaging studies for lower-back pain. Measures in other categories evaluate other aspects of patients' experiences (e.g., the number of customer service calls abandoned) and the business aspects of the health plans (e.g., financial stability). Over time, HEDIS has evolved to meet changing standards of healthcare and in response to regulatory changes, and NCQA now publishes changes to HEDIS measures on an annual basis.