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The impact of the new HEDIS guidelines: practical considerations. Based on a presentation by Earl P. Steinberg, MD,
Insights
Controlling diagnosed hypertension is crucial for quality healthcare due to its prevalence and costs. The new Health Employer Data and Information Set (HEDIS) measure enhances accountability for blood pressure control in health plans.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Healthcare Quality Improvement
Background:
- Hypertension is a highly prevalent condition associated with significant morbidity, mortality, and healthcare costs.
- Despite documented benefits of blood pressure control, many patients in the United States remain poorly managed.
- The introduction of the Health Employer Data and Information Set (HEDIS) hypertension measure in 2000 established public accountability for health maintenance organizations regarding hypertension management.
Framework:
- The HEDIS hypertension measure assesses the proportion of eligible patients with diagnosed hypertension whose blood pressure is controlled below 140/90 mm Hg.
- This seemingly straightforward measure involves intricate complexities in identifying eligible patients and collecting accurate data.
- Effective implementation hinges on robust patient identification and precise data collection methodologies.
Implementation:
- Accurate identification of enrollees with diagnosed hypertension is a critical first step.
- Developing efficient and user-friendly data collection processes is essential for physician participation.
- Addressing physician receptivity through meaningful incentives and streamlined data submission can improve compliance.
Implications:
- Public accountability through HEDIS can drive improvements in hypertension control rates.
- Addressing implementation complexities is vital for the successful application of quality measures.
- Enhanced hypertension management can lead to reduced long-term morbidity, mortality, and healthcare expenditures.
Abstract:
There are several compelling reasons to focus on the control of diagnosed hypertension as a quality of care measure. Hypertension is a very prevalent disease, with substantial associated morbidity, mortality, and costs. Although the benefits of adequate blood pressure control are well documented, numerous studies have shown that blood pressure is poorly controlled in the United States. With the institution of the new Health Employer Data and Information Set (HEDIS) hypertension measure in January 2000, health maintenance organizations become publicly accountable for their performance in controlling blood pressure in their enrollees who have diagnosed hypertension. Although the new HEDIS hypertension measure--the proportion of eligible patients whose representative blood pressure is less than 140/90 mm Hg--seems simple on the surface, there are dozens of complexities underlying it. Identification of eligible enrollees with diagnosed hypertension and appropriate data collection are key. Many believe that physicians are likely to be more receptive to providing blood pressure data on their patients if they receive something meaningful in return and if data collection is easy, not too time consuming, and not too costly or disruptive.