NCQA improves health care by measuring its quality. Then we share what we learn with people who buy health care (employers) and use health care (consumers) so they’ll know where to get good care.
Fortunately, what gets measured gets improved. It’s just human nature that people work harder and smarter to do a good job when they know others are paying attention.
How We Do It
NCQA has the most widely used and respected tool for measuring quality, the Healthcare Effectiveness Data and Information Set (HEDIS) . More than 1,000 health plans covering almost 40% of the U.S. population use it.
HEDIS shows how often health insurance plans provide scientifically recommended tests and treatments for more than 70 aspects of health.
HEDIS evaluates how often people get preventive care—tests and treatments to keep them from getting sick. These include:
- Flu shots
- Help quitting smoking
- Screenings for breast, cervical and colon cancer
HEDIS also measures whether people with chronic conditions like asthma, diabetes and high blood pressure get care that can keep them healthy. For example, how often do people with:
- Asthma get appropriate medications to keep them out of hospitals and emergency departments
- Diabetes get testing and treatment that controls their blood sugar, cholesterol and blood pressure, and foot and eye exams that prevent amputations and blindness.
- High blood pressure have it under control
HEDIS includes measures for children. For example, how often do they get:
- Well-child care
- Counseling on weigh and nutrition and physical activity to fight obesity
The HEDIS measures for older adults evaluate how often seniors get
- Drugs that are dangerous for elderly people to take
- Testing and treatment to prevent bone loss
- Help preventing dangerous falls
- Help controlling incontinence
HEDIS evaluates whether doctors and nurses make the best use of heath care resources or provide unnecessary care that may harm patients, including:
- How often people get antibiotics for conditions that antibiotics don’t treat
- How often people with low back pain get unnecessary, potentially harmful imaging like x-rays
- How often people are readmitted to hospitals, because of poor follow-up care
In short, HEDIS finds out, “How good was your care?”. But it is also important to hear about people’s own experience of care – whether they got the care they needed timely and their overall views of their health plans and doctor. So we also look at the Consumer Assessment of Health Plans Survey (CAHPS).
CAHPS asks patients about their “experience of care.” For example:
- Did you always get care when you needed it?
- Was customer service staff helpful and polite?
- Did doctors listen to you and explain things in a way that you could understand?
Combining HEDIS and CAHPS is the key to how we accredit and rank insurers so that consumers know where to find the best value. It shows insurers and health professionals where they need to do better.
*HEDIS is a registered trademark of the National Committee for Quality Assurance.
*CAHPS is a registered trademark of the Agency for Healthcare Research and Quality, which oversees the survey.