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Do HEDIS measures reflect cost-effective practices?

Peter J Neumann1, Bat Sheva Levine

  • 1Program on the Economic Evaluation of Medical Technology, Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts 02115, USA. pneumann@hsph.harvard.edu

American Journal of Preventive Medicine
|October 31, 2002
PubMed
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The Health Plan Employer Data and Information Set (HEDIS) measures generally align with cost-effective healthcare practices. However, refining existing measures and adding new ones, especially for promoting healthy behaviors, could improve societal resource efficiency.

Area of Science:

  • Health Economics
  • Health Services Research
  • Outcomes Research

Background:

  • The Health Plan Employer Data and Information Set (HEDIS) is a set of performance measures used by managed care plans.
  • Quantifying the cost-effectiveness of HEDIS measures is crucial for ensuring efficient resource allocation in healthcare.
  • Previous assessments have not fully evaluated the economic value of clinical practices underlying HEDIS measures.

Purpose of the Study:

  • To examine the cost-effectiveness evidence for clinical practices associated with HEDIS 2000 measures.
  • To identify cost-effective interventions not currently included in HEDIS.
  • To inform strategies for enhancing the efficiency of healthcare resource utilization.

Main Methods:

  • Systematic review of economic evaluations from two databases (Harvard School of Public Health Cost-Utility Registry, Health Economics Evaluation Database).

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  • Inclusion of cost-effectiveness ratios for interventions and populations matching HEDIS 2000 measures.
  • Search for cost-effective interventions (<$20,000/life-year or quality-adjusted life-year gained) not covered by HEDIS.

    • Main Results:

    • Cost-effectiveness data were available for 11 of the 15 HEDIS measures reviewed.
    • The cost-effectiveness of HEDIS-related practices varied widely, from cost-saving to $660,000 per life-year gained.
    • Numerous interventions, particularly those promoting healthy behaviors, demonstrated cost-effectiveness but were not part of HEDIS.

    Conclusions:

    • HEDIS measures largely reflect cost-effective practices, though cost-effectiveness may vary for specific subgroups.
    • Challenges in assessing cost-effectiveness include data quality, availability, and study perspective.
    • Opportunities exist to refine HEDIS and develop new measures to promote greater societal resource efficiency in healthcare.