HEDIS® Measures
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.
For more information about HEDIS, please visit the following NCQA website: NCQA.org/hedis/ or reach out to our Clinical Quality team at ClinicalQualityNV@uhc.com.
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. 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 & Learn Series consists of presentations created by registered nurses on various HEDIS topics. These materials are updated annually or as changes are implemented.
- UnitedHealthcare Quality Reference Guide
- UnitedHealthcare Social Determinants of Health
- Adult Provider Resource Guide
- Coding Tool MY2022
- Coding Tool MY2023
- Lunch & Learn Series Measurement Year (MY)2022
Below is a breakout of key priority measures along with measure resources and supplemental information.
CAHPS®
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.
