December 16, 2021
The number of Americans enrolled in health plans that report quality results using the Healthcare Effectiveness Data and Information Set (HEDIS®) has grown to over 200 million, the National Committee for Quality Assurance (NCQA) announced today.
This record number of “covered lives” in HEDIS equals 60% of the United States population and strengthens its position as the most widely used performance improvement tool in health care.
“200 million people enrolled in health plans that report HEDIS results means 200 million people living longer, healthier lives,” said NCQA founder and president, Margaret E. O’Kane. “To have so many people benefit from the measurement, transparency and accountability HEDIS brings to health care is a milestone achievement and a credit and to the health plans that work so hard to achieve and report good results.”
Enrollment by product line in health plans that report HEDIS results:
- Commercial: 113,983,041.
- Medicaid Managed Care: 59,233,614.
- Medicare Advantage: 24,841,565.
- Marketplace: 11,300,000.
The widespread use of HEDIS in quality reporting makes it the backbone of performance-based contracting. CMS requires Medicare Advantage plans to report HEDIS results. Fourteen of the 16 clinical quality measures it uses to identify and reward high-quality health plans in the Medicare Star Rating system are HEDIS measures.
How HEDIS Works
HEDIS is a portfolio of quality measures that assess more than 90 aspects of health. Each measure essentially asks health plans, “How often does the right thing happen?” The “right thing” is a scientifically recommend screening, test or treatment for health plan members with a specific health issue.
HEDIS results—“rates”—are usually percentages expressed as whole numbers to one decimal place. For example, a HEDIS rate of 80.1 means that 80.1% of a health plan’s members who have a given health issue receive evidence-based care for that issue.
Health plans report HEDIS results to NCQA in June for the previous calendar year, following a rigorous audit process. Audited results make HEDIS the source of trusted data that underlie billions of dollars of value-based contracts.
Payer and provider trust in HEDIS also forms the foundation for future directions in quality and value. NCQA is adapting HEDIS to create a digital measurement ecosystem in which actionable, validated data flow freely and help organizations reveal, reward and improve quality in new ways.
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s Web site (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can be found online at ncqa.org, on twitter@ncqa, on Facebook at facebook.com/NCQA.org/, and on LinkedIn at linkedin.com/company/ncqa.