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Related Experiment Videos

NCQA implements new outcomes audit standards

    Healthcare Benchmarks
    |May 7, 1997
    PubMed
    Summary

    New auditing standards aim to improve the credibility of Healthcare Effectiveness Data and Information Set (HEDIS) outcomes. Certified auditors will be trained, and independent firms will audit Medicare managed care organizations in the interim.

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    Area of Science:

    • Healthcare Quality Measurement
    • Health Services Research
    • Health Policy

    Background:

    • Concerns exist regarding the comparability of Healthcare Effectiveness Data and Information Set (HEDIS) outcomes due to flawed data gathering and auditing.
    • The credibility of HEDIS data is crucial for evaluating healthcare quality and performance.

    Purpose of the Study:

    • To address the challenges in HEDIS data comparability and enhance the reliability of quality outcome standards.
    • To introduce new auditing standards to bolster the credibility of HEDIS data.

    Main Methods:

    • Implementation of new auditing standards by the National Center for Quality Assurance (NCQA).
    • Training a new class of certified auditors to implement these standards.
    • Engagement of independent firms for auditing Medicare managed care organizations during the transition period.

    Main Results:

    • The NCQA is actively working to improve the integrity of HEDIS data through revised auditing protocols.
    • A transitional phase involving independent auditors is established while certified auditors are trained.

    Conclusions:

    • The new auditing standards are expected to significantly improve the comparability and credibility of HEDIS outcomes.
    • These measures are vital for ensuring accurate healthcare quality assessments and maintaining public trust in healthcare performance data.

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