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HEDIS Measures and Technical Resources

190 million people are enrolled in plans that report HEDIS results. That makes HEDIS one of health care’s most widely used performance improvement tools. HEDIS includes measures for physicians, PPOs and other organizations. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through MyNCQA.

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

Respiratory Conditions

Cardiovascular Conditions

Diabetes

Musculoskeletal Conditions

Behavioral Health

Medication Management and Care Coordination

Overuse/Appropriateness

Measures Collected Through the Medicare Health Outcomes Survey

Measures Collected Through the CAHPS® Health Plan Survey

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.

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).

  • Order this publication (Anticipated Released Date: September 2019)
  • Technical Specifications Update (Will be posted on October 1, 2019)

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.

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 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.

Technical Specifications for Physician Measurement

HEDIS quality and cost of care measures for physician-level measurement.

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).

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.

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 2017

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).

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