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HEDIS 1999 effectiveness of care measures: implementation issues.

K A Hiltunen1

  • 1BlueCross BlueShield, Rochester, NY, USA.

Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality
|January 6, 2000
PubMed
Summary

The Health Plan Employer Data and Information Set (HEDIS) provides evolving criteria for health maintenance organizations (HMOs). Understanding HEDIS changes is crucial for HMOs seeking National Committee for Quality Assurance (NCQA) accreditation.

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Area of Science:

  • Healthcare Quality Measurement
  • Health Plan Performance Evaluation

Background:

  • The Health Plan Employer Data and Information Set (HEDIS) is a standardized set of performance measures for health maintenance organizations (HMOs).
  • HEDIS is owned and maintained by the National Committee for Quality Assurance (NCQA), a key organization in healthcare accreditation.
  • HEDIS criteria have progressively become more complex annually since its inception.

Purpose of the Study:

  • To detail the specific modifications implemented in HEDIS for the 1999 reporting year.
  • To anticipate potential alterations and developments in HEDIS for the upcoming 2000 period.
  • To guide health plans in leveraging HEDIS data for successful NCQA accreditation preparation.

Main Methods:

  • Review of HEDIS 1999 specifications and documentation.

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  • Analysis of trends and NCQA communications regarding future HEDIS development.
  • Examination of the relationship between HEDIS performance metrics and NCQA accreditation requirements.

    • Main Results:

    • HEDIS 1999 introduced specific changes impacting HMO data collection and reporting.
    • Anticipated HEDIS 2000 modifications suggest a continued focus on performance metrics.
    • Health plans can strategically utilize HEDIS data to align with and meet NCQA standards.

    Conclusions:

    • HEDIS is an integral tool for assessing and improving HMO performance.
    • Proactive engagement with HEDIS evolution is essential for health plans aiming for NCQA accreditation.
    • Effective use of HEDIS data can provide a competitive advantage in the managed care market.