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How does HEDIS affect quality improvement strategies in an HMO?
1NYLCare Health Plans, New York City, USA.
Managed Care Interface
|October 4, 1997
Summary
Health plans should prioritize general quality improvement strategies over solely focusing on Health Plan Employer Data and Information Set (HEDIS) compliance. This approach better supports overall quality measurement and enhancement for health maintenance organizations (HMOs).
Area of Science:
- Health Services Research
- Quality Improvement Science
- Healthcare Management
Background:
- Health plans invest significant resources in meeting Health Plan Employer Data and Information Set (HEDIS) reporting requirements.
- The increasing importance of HEDIS raises questions about its influence on health maintenance organization (HMO) quality improvement strategies.
Purpose of the Study:
- To evaluate the role of HEDIS in shaping HMO quality improvement strategies.
- To determine if quality improvement efforts should be narrowly focused on HEDIS or broadly encompass general quality measurement.
Main Methods:
- Case study analysis of NYLCare Health Plans, Inc.'s experience.
- Qualitative assessment of quality improvement strategy formulation in response to reporting standards.
Main Results:
- NYLCare's experience indicates that quality improvement strategies are often driven by HEDIS compliance.
- A potential overemphasis on HEDIS may detract from broader quality improvement goals.
Conclusions:
- HMO quality improvement strategies should be designed to address general quality measurement and improvement objectives.
- Focusing solely on HEDIS may not be the most effective approach for comprehensive quality enhancement in healthcare plans.
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