A set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to assess the quality of care and services provided by health plans. HEDIS measures cover various aspects of healthcare, including preventive care, treatment effectiveness, and patient satisfaction.
Specific metrics used to evaluate the performance of healthcare providers and health plans. These measures assess various aspects of care delivery, such as screening rates, medication adherence, and management of chronic conditions.
Healthcare services aimed at preventing illness, injury, or disease. HEDIS includes measures related to preventive care, such as immunization rates, cancer screenings, and annual wellness exams.
The extent to which healthcare interventions and treatments achieve desired outcomes. HEDIS measures clinical effectiveness by evaluating factors such as appropriate medication use, adherence to treatment guidelines, and management of chronic conditions.
Refers to patients’ perceptions of their interactions with healthcare providers and the healthcare system. HEDIS assesses patient experience through measures such as patient satisfaction surveys and assessments of access to care.
The extent to which healthcare services are used by patients. HEDIS measures utilization by evaluating factors such as emergency department visits, hospital readmission rates, and utilization of preventive services.
Processes for gathering, analyzing, and reporting healthcare data required for HEDIS measurement. Health plans collect data from various sources, including medical records, claims data, and patient surveys, to report on HEDIS measures annually.
The comparison of an organization’s performance against industry standards or best practices. Health plans use HEDIS benchmarks to evaluate their performance relative to other plans and identify areas for improvement.
Initiatives aimed at enhancing the quality of care and services provided by health plans. HEDIS data guides performance improvement efforts by identifying areas where interventions are needed to improve outcomes and patient satisfaction.
Formal recognition of a health plan’s compliance with quality standards and performance measures, including those outlined in HEDIS. Accreditation by organizations such as NCQA demonstrates a health plan’s commitment to quality improvement and adherence to best practices in healthcare delivery.