Healthcare Effectiveness Data and Information Set (HEDIS) is a nationally recognized quality measurement framework used by more than 90% of health plans. Its purpose is to evaluate performance on critical dimensions of care and service, ensuring that members receive evidence-based, clinically appropriate, and cost-effective care. Currently, more than 190 million individuals are enrolled in health plans that use HEDIS to collect and report quality results. HEDIS data are also made available to healthcare and medical providers to support value-based care, monitor cost-effectiveness, and evaluate the appropriateness and consistency of clinical interventions.
To ensure that HEDIS continues to reflect current standards of effective, high-quality care, the National Committee for Quality Assurance (NCQA) conducts an annual review and update process. This process includes collecting survey results and performance data directly from health plans and other reporting organizations, then using those insights to refine measures, specifications, and reporting requirements.
NCQA currently supports two primary reporting methods for HEDIS: the Electronic Clinical Data System (ECDS) methodology and the traditional (claims and medical record-based) review method. In 2021 and 2022, organizations were required to use both methods for certain measures to compare results and assess how different data sources influence performance. For cancer screening, for example, NCQA found that rates reported via ECDS and traditional methods were closely aligned for most plans, providing confidence in the integrity of ECDS-based reporting.
Looking ahead, HEDIS is evolving to support a more integrated, data-driven, and equitable healthcare ecosystem. Key priorities include increasing flexibility in measure use, streamlining and updating technical specifications, improving data accuracy and interoperability, enabling features that integrate directly with users’ systems, enhancing population health insights at both individual and cohort levels, advancing health equity measurement, and expanding support for telehealth and other virtual modalities.
For MCO leaders, HEDIS season is no longer a short-term operational spike, it is a recurring, strategic inflection point that directly impacts contract performance, quality revenue, and member trust. Drawing on more than 20 years of HEDIS-specific experience and deep partnerships with Managed Care Organizations, RepuCare supplies specialized clinicians and administrative professionals to manage chart review, abstraction, documentation standards, and regulatory compliance at scale. To stabilize your HEDIS workforce, protect quality scores, and reduce reliance on high-cost, last-minute solutions, connect with RepuCare to explore a tailored HEDIS staffing strategy for your next measurement year.