HEDIS Reporting: A Pathway to Better Health Outcomes

Healthcare policymakers, providers, and patients all share the goal of improving health outcomes. However, achieving this goal requires having the right data to identify opportunities and benchmark progress. This is where HEDIS reporting comes in.

What is HEDIS?

HEDIS, or the Healthcare Effectiveness Data and Information Set, is a set of standardized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS measures cover a range of important health issues, from preventative screenings to chronic disease management. The measures are based on evidence-based clinical guidelines and established standards of care.

HEDIS data is collected annually from the vast majority of US health plans. The aggregated, de-identified data provides a comprehensive picture of the effectiveness of healthcare delivery and allows for benchmarking and comparison. Health plans can use HEDIS to identify gaps in care and quality improvement opportunities.

Why HEDIS Matters for Health Outcomes

HEDIS enables a data-driven approach to improving population health outcomes in three key ways:

• Pinpointing Gaps in Care – Because HEDIS measures focus on evidence-based standards of care, low-performance rates shine a spotlight on potential gaps that need to be addressed. For example, if HEDIS data shows low rates of childhood immunizations or diabetes eye exams for a particular health plan or population, targeted interventions can be implemented to improve compliance.
• Tracking Performance Over Time – The ability to compare HEDIS measure rates year-over-year allows health plans to see where they are making progress and where more work is needed. Trending HEDIS data enables plans to double down on successful quality initiatives and course-correct those that are not moving the needle.
• Benchmarking and Goal Setting – The standardized nature of HEDIS allows for apples-to-apples comparisons across different health plans and populations. By benchmarking against high performers as well as national and regional averages, health plans can set measurable goals for improvement. Comparing HEDIS rates to established benchmarks is a catalyst for better quality.

HEDIS Reporting Driving Better Health Outcomes

When leveraged effectively, the data generated from HEDIS Reporting provides a pathway to directly impact patient care and population health. Here are some examples of how HEDIS reporting helps drive better health outcomes:

• Preventative Care – Low HEDIS rates on measures such as childhood immunization, cervical cancer screening, and flu shots can prompt targeted outreach and education campaigns. Resulting increases in preventative care lead to a healthier population.
• Chronic Disease Management – HEDIS measures around diabetes, hypertension, and depression assess adherence to recommended care standards. Identifying and addressing care gaps for chronic conditions improves outcomes.
• Medication Management – Medication adherence and monitoring measures let health plans know if members are taking medications as prescribed. Interventions to remove barriers and improve compliance lead to better medication management.
• Behavioral Health – HEDIS measures related to depression screening, post-discharge follow-up, and substance abuse help strengthen behavioral health services. Better behavioral health improves overall well-being.
• Health Equity – Analyzing HEDIS rates by demographic factors can reveal disparities impacting disadvantaged populations. Targeted quality initiatives can then promote health equity.
• Patient Experience – Member satisfaction surveys provide insight into access, communication, and other aspects of patient experience. Improving experience leads to the utilization of beneficial services.

HEDIS reporting supplies the data foundation health plans need to identify opportunities and drive measurable improvements in the effectiveness of care delivery. When HEDIS data is acted upon, it translates directly to higher quality care and better health outcomes for patients and populations. In short, HEDIS is an invaluable tool for powering healthcare’s ongoing journey to provide the highest possible value.