With Medicare transitioning from a fee-for-service model to  value-based care programs with value based payments, there is a need for standardized assessments that accurately measured the value of the health care received in a medical institution. The Centers for Medicare & Medicaid Services(CMS) has been working to rate the quality of care and adapt alternative payment models. They also offer incentive payments to reward those care providers who have high standardized scores, which encourages providers to give the best patient care they can.  

In 1992, CMS partnered with the National Committee for Quality Assurance (NCQA) to develop one standardized care assessment called the Healthcare Effectiveness Data and Information Set (HEDIS). This article will examine the HEDIS and how you can raise your score to make your plan stand out from the rest.

What is HEDIS?

HEDIS is a set of standardized performance measures that provide consumers with the information they need to accurately compare health plan performance. The HEDIS measures are designed specifically for special needs plans (SNPs). HEDIS has measures that relate to notable public health issues including cancer, heart disease, smoking, asthma, and diabetes according to CMS.gov.

HEDIS Measurements

To provide complete quality measures, HEDIS includes over 90 measures across 6 domains of care as reported by NCQA's official website. Connecting to the official NCQA website can also show you more technical information on HEDIS. The wide range of HEDIS measures helps promote quality improvement of providers’ care and also produces better health outcomes for policyholders. Below are overviews of the HEDIS measures.

Effectiveness of Care

As one measure, HEDIS focuses on measuring the effectiveness of the care that policyholders receive. This includes prevention and screening measures that care providers use. It also considers the provider’s care for respiratory, cardiovascular, and musculoskeletal conditions. Finally, this HEDIS measure considers the care provided for diabetes, behavioral health, and several other conditions.

Access/Availability of Care

HEDIS also considers the accessibility of providers’ services beyond base care. They look at policyholders' access to ambulatory health services, annual dentist visits, prenatal and postpartum care, and other services. 

Utilization and Risk-adjusted Utilization

HEDIS measures policyholders’ use of the services provided to them. Regular utilization includes child and adolescent well-care visits, mental health care, and antibiotic treatments. Risk-adjusted utilization measures the care use of policyholders who are at higher risk, like senior citizens. This care utilization includes hospitalization in different scenarios and emergency department utilization.

Measures Reported Using Electronic Clinical Data Systems

Finally, HEDIS considers whether the provider’s care measures are reported in electronic clinical data systems. These systems prevent sharing sensitive information illegally because the data is encrypted and transmitted securely. Some specific reports this domain covers are cancer screenings, follow-up care for children prescribed ADHD medication, and depression screenings.

Raise Your HEDIS Results

With the thoroughness of HEDIS measures, your plan’s HEDIS results can show high value quickly to potential policyholders. Peerfit Move and our integrated digital streaming platform FitOn provides course training specific to senior citizens that can help increase your HEDIS results. FitOn Health includes expert-led courses that help seniors with lowering blood sugar, diabetes, stress, sleep, MSK, fall prevention, and more. These assets can help senior citizens improve their overall fitness and wellness, which then improves your HEDIS results.  

When you include Peerfit Move as a benefit, we will package programming specific to your needs that addresses the primary areas of the HEDIS scoring system. Let us help you provide higher-quality wellness benefits to your members and raise your HEDIS results.

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