Measuring the performance of a health plan
The Healthcare Effectiveness Data and Information Set, or HEDIS1 is a set of standards used to measure the performance of a health plan. In other words, HEDIS is a report card for managed care plans.
HEDIS was developed by representatives from consumer groups, employers, health plans and the National Committee for Quality Assurance (known as NCQA). The items it measures, includes the following:
- Access and availability of care
- Cost of care
- Effectiveness of care
- Health plan stability
- Member satisfaction
- Use of services
The findings also are an important resource for self-evaluation. When we compare our annual HEDIS findings with those from previous years and national standards, we can identify our strengths as well as highlight opportunities for improvement.
On an ongoing basis, we also send surveys to our members to gather feedback about their experience with our services and providers. Our members’ experience is a valuable tool we use to ensure we’re delivering quality health care.
We collect and publish HEDIS information annually so customers can follow our progress, identify trends and see our ongoing commitment to improved performance. HEDIS findings help employer and consumer groups answer the fundamental question, "What health plan provides the best value?"
Below are some of the health issues that HEDIS measures:
- Controlling high blood pressure
- Caring for diabetes
- Screening for breast cancer
- Managing asthma medication
- Managing antidepressant medication
- Tracking childhood and adolescent immunizations
- Assessing childhood and adult weight
To learn more about HEDIS measurement, see our detailed HEDIS overview.
1HEDIS is a registered trademark of the National Committee for Quality Assurance.