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New HEDIS means more information about HMOs

P L Grimaldi1

  • 1Birch & Davis Health Management Corporation, Silver Spring, MD, USA.

Journal of Health Care Finance
|July 1, 1997
PubMed
Summary

The Health Plan Employer Data and Information Set (HEDIS) offers standardized performance measures for comparing managed care plans. HEDIS 3.0 now includes Medicare members, expanding its utility for consumers and purchasers.

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Area of Science:

  • Healthcare performance measurement
  • Managed care quality assessment

Background:

  • Managed care organizations (MCOs) require standardized performance metrics.
  • Purchasers and consumers need reliable data to compare MCOs.
  • Previous HEDIS versions lacked comprehensive scope for all MCO members.

Purpose of the Study:

  • To introduce the latest version of the Health Plan Employer Data and Information Set (HEDIS).
  • To highlight the expanded scope of HEDIS 3.0, including Medicare members.
  • To detail the standardized measures for comparing managed care plan performance.

Main Methods:

  • Development of a standardized set of 71 performance measures.
  • Consolidation of previous HEDIS versions into HEDIS 3.0.
  • Extension of measure applicability to Health Maintenance Organization (HMO) Medicare members.

Main Results:

  • HEDIS 3.0 provides a comprehensive tool for performance comparison.
  • The 71 measures cover eight key topics relevant to stakeholders.
  • Enhanced data allows for more informed decision-making by purchasers and consumers.

Conclusions:

  • HEDIS 3.0 represents a significant advancement in managed care performance measurement.
  • The standardized measures facilitate objective comparison of MCOs.
  • Expanded use cases improve transparency and accountability in healthcare.

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