If you have health insurance, chances are your health plan is measuring the care you receive through the National Committee for Quality Assurance’s (NCQA) HEDIS® Short for Healthcare Effectiveness Data and Information Set, HEDIS® is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. From Colorectal Screening to Medication Management in the Elderly, HEDIS® measures how often practitioners are asking the right questions and performing the right tests and screenings. Altogether, HEDIS consists of 81 measures across 5 domains of care. Because so many plans collect HEDIS® data, and because the measures are so specifically defined, HEDIS® makes it possible to compare the performance of health plans on an “apples-to-apples” basis.
Every year, NCQA seeks the public’s help on new and revised HEDIS® measures. This is an opportunity for health plans, purchasers, consumers and other stakeholders to weigh in on the relevance, scientific soundness and feasibility of new and revised measures.
For 2017, NCQA proposes:
• Two new measures on follow-up after emergency department visits for patients who have mental illness or alcohol and other drug dependence.
• One new measure on standardized health care-associated infection ratio.
• One new measure on depression remission or response for adolescents and adults.
• Revisions to seven existing measures.
About HEDIS and Public Comment
HEDIS comprises measures of clinical quality and patient experience that are based on published clinical guidelines and published scientific evidence. When clinical guidelines change or new evidence becomes available in the scientific literature, NCQA reviews HEDIS measures to determine whether changes may be needed. NCQA convenes multi-stakeholder advisory groups—including independent scientists, clinicians, consumers and purchasers—to ensure that the measures meet and balance the high standards of relevance, scientific soundness and feasibility.
An important part of developing and updating HEDIS is to provide the opportunity for the public to review and comment on draft measures. NCQA reviews every comment received during public comment and presents results to its multi-stakeholder advisory groups and the NCQA Committee on Performance Measurement for deliberation.
NCQA’s HEDIS measures do not constitute clinical practice guidelines, nor should they be used to determine insurance or coverage.
How to Participate in Public Comment
To read and comment on the proposed changes, visit http://www.ncqa.org/HomePage/NCQAPublicComments.aspx. The public comment period begins at 12:00 PM (EST) on February 16 and ends at 11:59 PM (EST) on March 16. NCQA will review input from public comment and will publish new and updated measures and guidelines in HEDIS 2017, Volume 2, in summer 2016.