Healthcare Effectiveness Data and Information Set (HEDIS)

Definition - What does Healthcare Effectiveness Data and Information Set (HEDIS) mean?

The Healthcare Effectiveness Data and Information Set (HEDIS) is an measuring instrument, developed and maintained by the National Committee for Quality Assurance (NCQA), and used by American health plans to determine and measure performance on the care and services industry. HEDIS has been developed to allow customers to compare the performance of a specific health plan with other plans; and to access national and regional benchmarks. This is sometimes called a health plan employer data and information set, particularly by health insurers.

WorkplaceTesting explains Healthcare Effectiveness Data and Information Set (HEDIS)

The Healthcare Effectiveness Data and Information Set (HEDIS) is divided into 81 measures that contain five "domains of care":

  • Effectiveness of Care
  • Access/Availability of Care
  • Experience of Care
  • Utilization and Relative Resource Use
  • Health Plan Descriptive Information

Providing so many measures allows the possibility of comparing performance of health plans point for point. HEDIS adds, deletes, and revises these measures annually depending on need and legislation. Data is collected through surveys, medical charts, and insurance claims for procedures, medical visits, and hospitalizations.

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