HEDIS Measures
HEDIS® measures performance in health care where improvements can make a meaningful difference in people’s lives.
Effectiveness of Care
Prevention and Screening
- Adult BMI Assessment
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
- Childhood Immunization Status
- Immunizations for Adolescents
- Lead Screening in Children
- Breast Cancer Screening
- Cervical Cancer Screening
- Colorectal Cancer Screening
- Chlamydia Screening in Women
- Care for Older Adults
Respiratory Conditions
- Appropriate Testing for Children With Pharyngitis
- Use of Spirometry Testing in the Assessment and Diagnosis of COPD
- Pharmacotherapy Management of COPD Exacerbation
- Medication Management for People With Asthma and Asthma Medication Ratio
Cardiovascular Conditions
- Controlling High Blood Pressure
- Persistence of Beta-Blocker Treatment After a Heart Attack
- Statin Therapy for Patients With Cardiovascular Disease and Diabetes
Diabetes
Musculoskeletal Conditions
- Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
- Osteoporosis Testing and Management in Older Women
Behavioral Health
- Antidepressant Medication Management
- Follow-Up Care for Children Prescribed ADHD Medication
- Follow-Up After Hospitalization for Mental Illness
- Follow-Up After Emergency Department Visit for Mental Illness
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence
- Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder
- Adherence to Antipsychotic Medications for Individuals With Schizophrenia
- Metabolic Monitoring for Children and Adolescents on Antipsychotics
Medication Management and Care Coordination
- Annual Monitoring for Patients on Persistent Medications
- Medication Reconciliation Post-Discharge
- Transitions of Care
- Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions
Overuse/Appropriateness
- Non-Recommended Cervical Cancer Screening in Adolescent Females
- Non-Recommended PSA-Based Screening in Older Men
- Appropriate Treatment for Children With Upper Respiratory Infection
- Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis
- Use of Imaging Studies for Low Back Pain
- Use of Multiple Concurrent Antipsychotics in Children and Adolescents
- Medication Management in the Elderly
- Use of Opioids at High Dosage
- Use of Opioids from Multiple Providers
Measures Collected Through the Medicare Health Outcomes Survey
- Fall Risk Management
- Management of Urinary Incontinence in Older Adults
- Physical Activity in Older Adults
Measures Collected Through the CAHPS® Health Plan Survey
Access/Availability of Care
- Adults’ Access to Preventive/Ambulatory Health Services
- Children and Adolescents’ Access to Primary Care Practitioners
- Annual Dental Visit
- Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment
- Prenatal and Postpartum Care
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
Utilization
Risk Adjusted Utilization
Measures Collected Using Electronic Clinical Data Systems
HEDIS Technical Resources
HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and sampling.
HEDIS 2020
Vol. 1: Narrative
Overview of the HEDIS measurement set and how the data are used.
Vol. 2: Technical Specifications for Health Plans
HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.
- Order the HEDIS Volumes
- HEDIS Volume 2 & Digital Measures Bundles Comparison
- Technical Specifications Update – (Posted October 1, 2019)
- Risk Adjustment Tables (Posted November 1, 2019)
- Medication List Directory (NDC codes) (Posted November 1, 2019)
Note: Available for free order in the NCQA Store. Once ordered, the Medication List Directory will be made available under the My Downloads section in My.NCQA. - HEDIS 2020 Measure Trending Determinations (Will be posted Spring 2020)
- HEDIS Electronic Clinical Data System (ECDS)
- HEDIS FAQs
HEDIS Measures Included in the 2020 Quality Rating System (QRS)
Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).
- HEDIS for the Quality Rating System Value Set Directory
- HEDIS for the Quality Rating System Technical Specifications
- Technical Specifications Update – Posted October 1, 2019
- HEDIS for the Quality Rating System FAQs
Technical Specifications for ACO Measurement
HEDIS quality measures for Accountable Care Organizations.
Vol. 3: Specifications for Survey Measures
HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.
- Order this publication
- CAHPS 5.0H Survey
- Survey Vendor Certification Program
- Technical Specifications Update (Posted November 15, 2019)
- 2020 Validated Member-Level File Layout (Will be posted January 2020)
Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures
The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.
- Order this publication
- HEDIS Compliance Audit
- Specification Updates (Posted December 10, 2019)
Vol. 6: The Medicare Health Outcomes Survey Manual
Technical specifications for the Health Outcomes Survey (HOS).
- Order this publication (Anticipated Released Date: February 2020)
- Health Outcomes Survey
HEDIS 2019
Vol. 1: Narrative
Overview of the HEDIS measurement set and how the data are used.
Vol. 2: Technical Specifications for Health Plans
HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.
- Order the HEDIS Volumes
- Technical Specifications Update – Posted October 1, 2018
- ECDS Technical Update – Posted December 12, 2018
- Risk Adjustment Tables – Updated April 2, 2019
- Risk Adjustment Tables for the Plan All-Cause Readmission Measure for HEDIS 2020 – Posted November 1, 2018
- Medication List Directory (NDC codes) – Posted November 1, 2018 (also used for ACO, QRS and Physician Measurement reporting)
- HEDIS 2019 Measure Trending Determinations – Posted April 9, 2019
- Rules for Allowable Adjustments for HEDIS Memo (pdf) – Posted July 2, 2018
- Allowable Adjustments RxNorm List (.xslx) – Posted November 13, 2018
- HEDIS Electronic Clinical Data System (ECDS)
- HEDIS FAQs
- Note: The Standardized Healthcare-Associated Infection Ratio (HAI) measure is suspended and will not be collected for HEDIS 2019. Due to the suspended status, the HAI Standard Infection Ratio (SIR) Final Table will not be posted. The complete HAI specifications are included in HEDIS 2018.
Technical Specifications for Physician Measurement
HEDIS quality and cost of care measures for physician-level measurement.
- Technical Specifications for Physician Measurement Memo – Posted November 14, 2018
HEDIS Measures Included in the 2019 Quality Rating System (QRS)
Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).
- HEDIS for the Quality Rating System Value Set Directory
- HEDIS for the Quality Rating System Technical Specifications
- Technical Specifications Update – Posted October 1, 2018
- HEDIS for the Quality Rating System FAQs
Technical Specifications for ACO Measurement
HEDIS quality measures for Accountable Care Organizations.
Vol. 3: Specifications for Survey Measures
HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.
- Order the HEDIS Volumes
- CAHPS® 5.0H Survey Certification
- 2019 Validated Member-Level File Layout – Posted June 14, 2019
Specifications for the CAHPS PCMH Survey
Technical specifications and standardized questionnaires for the CAHPS survey for the patent-centered medical home (PCMH).
Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures
The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.
Vol. 6: The Medicare Health Outcomes Survey Manual
Technical specifications for the Health Outcomes Survey (HOS).
HEDIS Archives
HEDIS 2018
- HEDIS 2018 Measure Changes (pdf)
- HEDIS 2018 Volume 2 Technical Specifications Update (pdf) – Posted October 2, 2017
- HAI Standard Infection Ratio (SIR) Final Table – Posted January 10, 2018
- Risk Adjustment Tables – Posted March 28, 2018
- Medication List Directory (NDC codes) – Posted February 8, 2018 (also used for ACO, QRS and Physician Measurement reporting)
- HEDIS 2018 Measure Trending Determinations (pdf) – Posted March 26, 2018
- HEDIS 2018 Physician Measures (pdf)
- Quality Rating System Technical Specifications Update (pdf)
- 2018 CAHPS Member-Level Data File Layout – Header Record (pdf)
- 2018 CAHPS Member-Level Data File Layout- Member Level Record (pdf) – Posted January 9, 2018
- HEDIS 2018 CAHPS Survey for PCMH Publication Status Update (pdf)
- HEDIS 2018 Volume 5 Specification Updates (pdf)
HEDIS 2017
- HEDIS 2017 Measures (pdf)
- HEDIS 2017 Physician Measures (pdf)
- HEDIS 2017 Vol. 2 Technical Specifications Update (pdf) - Posted October 3, 2016
- HAI Standard Infection Ratio (SIR) Final Table (.xls) – Posted January 4, 2017
- HAI Hospital/Provider ID File (.xls) - Posted January 4, 2017
- Risk Adjustment Tables - Posted November 1, 2016
- National Drug Code List (NDC) - Posted November 1, 2016
- Relative Resource Use Measures will not be collected for HEDIS 2017 (pdf) – Posted January 27, 2017
- HEDIS 2017 Measure Trending Determinations (pdf) – Posted March 2, 2017
- Quality Rating System: Technical Specifications Update (pdf) – Posted October 3, 2016
- 2017 ACO Memo (pdf)- Posted November 15, 2016
- Vol. 3: Technical Specifications Update (pdf) – Posted November 16, 2016
- 2017 Validated Member-Level File Layout (pdf) – Posted January 21, 2017
- HEDIS 2017 P4P & Vol. 5 Specification Updates (pdf) – Posted December 28, 2016
Rules for Allowable Adjustments of HEDIS
Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives. The rules provide flexibility for evaluating different populations without altering measures’ clinical intent (e.g., removal of continuous enrollment or product-line criteria).
The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. NCQA’s HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications.
HEDIS FAQ
Visitors to this page often check HEDIS FAQs or ask a question through MyNCQA.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).