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  • Writer's pictureRepuCare

Here comes HEDIS Season!

Healthcare Effectiveness Data and Information Set (HEDIS) is a quality measurement tool used by more than 90% of healthcare insurance plans. Its goal is to measure performance on various vital considerations of care and service ensuring patients are receiving the most effective care possible. Currently, more than 190 million people enrolled in healthcare plans using HEDIS and report quality results. HEDIS is also made available to healthcare and medical providers to ensure costs are effective and appropriateness of care is properly evaluated.

To ensure that HEDIS continues to measure effective and quality healthcare, the National Committee for Quality Assurance (NCQA) has established a process to evaluate its measurements each year. This process involves collecting survey results directly from health plans and organizations.

There are two methods that NCQA has in place for HEDIS. These include the Electronic Clinical Data System (ECDS) and the more traditional review method. In 2021 and 2022 it was required to use both methods when evaluating healthcare in order to compare the results and assess how data sources impacted performance. When screening for cancer, for example, it was found that ECDS reporting and traditional reporting were very close for most plans in rate totals.

The future of HEDIS is bright and focuses on a few main goals including, but not limited to, flexibility, update requirements, ensuring accuracy, features that download directly into user’s systems bringing more ease, insight regarding managing the health of individuals and groups, health equity, and telehealth expansion.

With 20+ years of HEDIS experience, RepuCare has a robust relationship with many MCOs in staffing support for HEDIS season as special skill sets are required for HEDIS nurses and admin to provide the most effective healthcare possible. Many of our HEDIS nurses work with us on a recurring basis when HEDIS season starts, and we maintain long-term relationships with all of our skilled contract nurses and administrative staff. We look forward to continuing this meaningful work with our clients!

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