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What is HEDIS used for?
The National Committee for Quality Assurance (NCQA) coordinates HEDIS testing and scorekeeping. The Centers for Medicare & Medicaid Services (CMS) uses HEDIS scores to monitor a health plan’s performance. More than 90% of American health plans use HEDIS scores to compare how well the plan performs in areas like:
- Quality of care
- Access to care
- Member satisfaction with the plan and providers
HEDIS measures
Performance measure: Childhood Immunization Status (CIS-CH) Combination Three (3)
Frequency: Annual
Definition: The percentage of Children two (2) years of age who had four diphtheria, tetanus, and acellular pertussis (DTaP); three polio (IPV); one (1) measles, mumps, and rubella (MMR); three (3) haemophilus influenza type B (HiB); three (3) hepatitis B (HepB), one (1) chicken pox (VZV); four (4) pneumococcal conjugate (PCV); one (1) hepatitis A (HepA); two (2) or three (3) rotavirus (RV); and two (2) influenza (flu) vaccines by their second birthday. Combination 3 (DTAP, IPV, MMR, HIB, Hepatitis B, VZV and PCV).
Performance measure: Well-Child Visits in the First Thirty (30) Months of Life (W30-CH)
Frequency: Annual
Definition: Well-Child Visits in the First Thirty (30) Months of Life: Assesses Children who turned fifteen (15) months old during the measurement year and had at least six (6) well-child visits with a primary care physician during their first fifteen (15) months of life. Assesses Children who turned thirty (30) months old during the measurement year and had at least two (2) well-child visits with a primary care physician in the last fifteen (15) months.
Performance measure: Immunizations for Adolescents (IMA- CH) Combination One (1)
Frequency: Annual
Definition: Assesses adolescents thirteen (13) years of age who had one (1) dose of meningococcal vaccine, one (1) Tdap vaccine and the complete human papillomavirus vaccine series by their thirteenth birthday.
Performance measure: Child and Adolescent Well-Care Visits (WCV-CH)
Frequency: Annual
Definition: l Child and Adolescent Well-Care Visits: Assesses Children three (3) to twenty-one (21) years of age who received one (1) or more well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.
Performance measure: Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC-CH)
Frequency: Annual
Definition: Timeliness of Prenatal Care. The percentage of deliveries in which women had a prenatal care visit in the first trimester, on or before the Enrollment start date or within forty-two (42) Days of Enrollment in the organization.
Performance measure: Ambulatory Care: Emergency Department (ED) Visits (AMB-CH)
Frequency: Annual
Definition: Assesses the rate of emergency department (ED) visits per one thousand (1,000) beneficiary months for Children and adolescents in each state.
Performance measure: Follow-Up After Hospitalization for Mental Illness: Ages Six (6) to Seventeen (17) (FUH-CH)
Frequency: Annual
Definition: Assesses the percentage of inpatient discharges for a diagnosis of mental illness or intentional self-harm among patients ages six (6) years to seventeen (17) that resulted in follow-up care with a mental health Provider within seven (7) and thirty (30) Days.
Performance measure: Prenatal and Postpartum Care: Postpartum Care (PPC-AD)
Frequency: Annual
Definition: Postpartum Care. The percentage of deliveries in which women had a postpartum visit on or between seven (7) and eighty-four (84) Days after delivery.
Performance measure: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPC-AD)
Frequency: Annual
Definition: Percentage of patients eighteen (18) to seventy-five (75) years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.
Performance measure: Plan All-Cause Readmissions (PCR-AD)
Frequency: Annual
Definition: Assesses the rate of adult acute inpatient and observation stays that were followed by an unplanned acute readmission for any diagnosis within thirty (30) Days after discharge among commercial (18 to 64), Medicaid (18 to 64) and Medicaid (18 and older) members.
Performance measure: Emergency Department Utilization (EDU)
Frequency: Annual
Definition: Assesses emergency department (ED) utilization among commercial (eighteen (18) and older) and Medicaid (eighteen (18) and older) CE members.
Performance measure: Follow-Up After Emergency Department Visit for Mental Illness: Age Eighteen (18) and Older (FUM-AD)
Frequency: Annual
Definition: The percentage of inpatient discharges for a diagnosis of mental illness or intentional self- harm among patients ages eighteen (18) years and older that resulted in follow-up care with a mental health Provider within seven (7) and thirty (30) Days.
HEDIS® is the property of the National Committee for Quality Assurance (NCQA).