What is HEDIS?
The acronym HEDIS stands for Healthcare Effectiveness Data and Information Set and according to the National Committee for Quality Assurance (NCQA), is the most widely used set of performance measures in the managed care industry. HEDIS is a tool consisting of over 90 measurements utilized to compare health plan quality across the nation and is a requirement to be an accredited health plan. The accreditation seal assures members/patients that they are being cared for by both a quality health plan and quality providers.
Provider Resources for Understanding Quality
Providers are vital to helping maintain accreditation status and ensuring quality care is delivered. By educating patients on the importance of cancer screenings, managing chronic conditions, addressing behavioral health matters, etc. providers are directly impacting the HEDIS rates.
Below are several resources to assist with the application of HEDIS metrics and gap closures. The UnitedHealthcare Quality Reference Guide is a detailed overview of the HEDIS measures with measure descriptions and details, coding recommendations and actionable takeaways. In the Resources section below, The Provider Resource Guide is a 1-page snapshot of key measures and actions. The Coding Tool offers guidance on NCQA approved codes that can be used to close HEDIS gaps in care, and the Lunch and Learn Series consists of presentations created by registered nurses on various HEDIS topics. These materials are updated annually or as changes are implemented.
Lunch and Learn
Join us for the annual HEDIS Lunch and Learn Series. This series will be hosted by the HPN/SHL clinical quality nurses and staff to educate and discuss resources, coding, documentation, and other measure opportunities. These sessions provide a personal and customized approach based on years of medical record review in Nevada. Jam sessions are a fun way to learn, discuss, and ask questions along with the flow of the presentation. The lunch and learn series are a combination of our annual HEDIS jam sessions while presenting the changes found in NCQA’s technical specifications.
Each session will be held at noon. Please email ClinicalQualityNV@uhc.com for meeting information.
- June 14: HEDIS 101 and Provider Resources (new offering)
- July 12: Coding and Closing Gaps in Care
- August 9: Pregnancy and Pediatric Measures
- September 13: Behavioral Health Measures
- October 11: Adult Measures
- November 8: Risk Adjustment 101; RAF and RADV (new offering)
Below is a breakout of key priority measures along with measure resources and supplemental information.
Health plans conduct a member satisfaction survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). CAHPS is a member survey that gauges satisfaction with services provided by the health plan as well as member perception of provider accessibility, the patient-physician relationship and provider communication. This survey is conducted annually and results are then compared with national benchmarks.
How can providers help?
- Open the lines of communication with your patients. Communicate thoroughly and in a way they can understand.
- Listen to your patients and make sure they understand what you have discussed/ordered, etc.
- Submit referrals and obtain authorizations as appropriate.
- Be aware of patient wait times and limit them when possible.
- Encourage preventive measures such as influenza and pneumococcal vaccines.
For further information on HEDIS, please see the details in the UHC Quality Reference Guide or feel free to reach out to the Clinical Quality team at ClinicalQualityNV@uhc.com.