HEDIS Life Cycle

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I Topic selection: There is a huge universe of potential performance measures for future versions of HEDIS. The first step is identifying measures that meet formal criteria for further development.  Once topics are identified, a literature review is conducted to find supporting documentation of the importance, scientific soundness and feasibility (HEDIS desirable attributes) of the topic and is put in to a work-up format.

II Development: Measures should be fully defined and tested before the health plan collects them. MAPs participate in this process; they help identify the best measures for assessing health care performance in clinical areas identified in the topic selection phase. Based on field testing results and proposed final specifications, the CPM determines if the measure will move forward to Public Comment.

III Public Comment: Any new measures or changes to existing measures are put forth for public comment.  Public comment lasts 30 days. The CPM reviews all comments before making a final recommendation on public comment measures.

IV  First year data collection: Organizations will collect, be audited on and report on first year measures, but results will not be publicly reported for individual organizations in the first year. This allows implementation problems to be ironed out before results count.

V Public reporting: Based on the first year measure results, the CPM decides if the measure is ready for public reporting. If approved, the measure is included in the next year’s HEDIS Volume 2.

VI Evaluation: NCQA staff continually monitors the performance of measures that are publicly reported. Statistical analysis, review of audit results and user comments contribute to evaluation. Information derived from analyzing the performance of existing measures is used to improve the development of the next generation of measures. Every measure is reevaluated at least every three years.

VII  Retirement: During reevaluation, if it is clear to the CPM that a measure no longer adds value commensurate with the cost of data collection and reporting, it may be retired.

For in-depth information about the quality measurement process, please refer to the HEDIS Volume 1: Narrative publication.