What are examples of HEDIS measures?

HEDIS Measures

  • Colorectal Cancer Screening.
  • Care for Older Adults.
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD.
  • Pharmacotherapy Management of COPD Exacerbation.
  • Controlling High Blood Pressure.
  • Persistence of Beta-Blocker Treatment After a Heart Attack.

What are the HEDIS measures for 2020?

HEDIS measures address a range of health issues including: asthma medication use; persistence of beta-blocker treatment after a heart attack; controlling high blood pressure; comprehensive diabetes care; breast cancer screening; antidepressant medication management; immunization status; and advising smokers to quit.

What are HEDIS measures 2021?

HEDIS® (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to objectively measure, report, and compare quality across health plans.

What are the 5 domains of HEDIS?

HEDIS Measures

  • Effectiveness of Care.
  • Access/Availability of Care.
  • Experience of Care.
  • Utilization and Risk Adjusted Utilization.
  • Health Plan Descriptive Information.
  • Measures Reported Using Electronic Clinical Data Systems.

Are HEDIS measures mandatory?

Q: Is my participation in HEDIS mandatory? A: Yes. Network participants are contractually required to provide medical record information so that we may fulfill our state and federal regulatory and accreditation obligations.

How HEDIS measures are calculated?

a) The HEDIS individual measure scores are calculated as proportional rates using the numerators and denominators that are reported per the NCQA measurement requirements. Measures will be dropped from star rating calculations and benchmarks if at least 50% of California plans cannot report a valid rate.

Is HEDIS mandatory?

HEDIS is State mandated activity that measures the quality of care being provided to our members using a subset of measures developed by the NCQA. Is my participation in HEDIS mandatory? ​Yes.

What is a good hedis score?

For those in the eye care industry, receiving excellent HEDIS scores can be financially beneficial, while also improving the quality of care. CMS uses a 5-‐star system to rate Health Plans, with 1 star being “poor” and 5 stars being “excellent.” Bonuses for high star ratings range from 1.5 percent to 5 percent.

How do I submit hedis measures?

  1. Submit to our customer portal via https://my.ncqa.org/ with the following information.
  2. Your HEDIS account manager (AM) will contact you when your plan is in our system. • Your AM is available throughout the entire data submission process to answer your questions.
  3. Complete the HOQ. •
  4. Complete the IDSS. •

What are HEDIS star measures?

The Star measures are made up of performance measures from HEDIS, CAHPS , HOS (measures comparison of members health plan assessment over 2 years), Prescription Drug Program and CMS administrative data. HEDIS consists of standardized performance measures.

What do you really know about HEDIS?

What Is HEDIS? HEDIS is a rating system that uses many different specific measures or standards to compare the performance and care of most health plans in the United States. The ratings are performed each year and cover an extremely broad range of issues affecting health plans.

What is Behavioral Health Managed Care?

Managing behavioral health plays a key role in the current emphasis for health care providers to deliver care that incorporates medical, behavioral and social risk factors. As managed behavioral health care grows, so does the need to discern the value of behavioral healthcare providers.