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HEDIS Measures of Care

About HEDIS

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by most HMO and PPO plans to measure performance on important dimensions of care and service. By providing objective, clinical performance data measures against a detailed set of measurement criteria, HEDIS helps purchasers and consumers compare health plans' performance. HEDIS measures address a broad range of important health issues.

  • Appropriate antibiotic use
  • Asthma
  • Breast, cervical and colorectal cancers
  • Cardiovascular disease
  • Care for older adults
  • Childhood and adolescent immunizations
  • COPD
  • Diabetes
  • High blood pressure
  • Hospital readmissions
  • Medication management
  • Mental illness
  • Prenatal and postpartum care
  • Smoking
  • Weight assessment
  • Patient experience (CAHPS)
  • Vaccinations for adults and older adults (CAHPS) 

HEDIS includes the CAHPS 5.0H survey. The CAHPS survey measures members' experiences with their health care in areas such as clinician communication and getting needed care quickly, and asks them to rate their health plan on a scale of 0-10.

HEDIS 2015 data collected for this report generally reflect services delivered during calendar year 2014. To ensure validity of HEDIS results, certified auditors review the data using the NCQA HEDIS Compliance Audit™ program. See the appendices for details about national averages and performance trends.

HOS Measures

Medicare Health Outcomes Survey (HOS) measures evaluate the physical and mental health of seniors enrolled in Medicare. HOS measures are the first quality measures for elderly populations that are based on patients' self-report, including health status. Including HOS as part of HEDIS measurement creates a broad way to evaluate the quality of care that health plans provide to Medicare beneficiaries. This report includes four HOS measures:

  • Fall Risk Management
  • Management of Urinary Incontinence in Older Adults
  • Osteoporosis Testing in Older Adults
  • Physical Activity in Older Adults 

Terms

NA: Measure rates have no available data. In some instances, data are not collected for a measure in a product line.

Rate: Unless otherwise stated, the statistical mean for reported data. Each measure is described by an average rate for each applicable product line.

A Note on Medicare Survey Data

Medicare CAHPS survey data and HEDIS measures collected through the survey (such as Flu Shots for Adults and Medical Assistance With Smoking and Tobacco Use Cessation) are not available when NCQA prints The State of Health Care Quality Report in October. NCQA will include those data in an updated version of this report in November.