HEDIS & Quality Measurement

HEDIS & Quality Measurement

 

    

 
HEDIS® (The Healthcare Effectiveness Data and Information Set) is the gold standard in health care performance measurement, used by more than 90 percent of the nation's health plans and many leading employers and regulators. 
HEDIS is a set of standardized measures that specifies how organizations collect, audit and report performance information across the most pressing clinical areas, as well as important dimensions of customer satisfaction and patient experience. 


Explore our HEDIS volume publications below:
  

HEDIS Volume 1: Narrative

HEDIS Volume 2: Technical Specifications for Health Plans

HEDIS Volume 3: Specifications for Survey Measures

HEDIS Volume 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

HEDIS Volume 6: Specifications for The Medicare Health Outcomes Survey

HEDIS Packages

HEDIS Technical Specifications for Physician Measurement

HEDIS Specifications for CAHPS PCMH Survey

Technical Specifications for ACO Measurement

2017 Quality Rating System (QRS) HEDIS Value Set Directory


    

 

 

 

HEDIS Volume 1: Narrative


 
HEDIS Volume 1 is an indispensable reference that will help you understand the science of health care quality measurement. The Narrative gives a background on what is in HEDIS and an explanation of why the measures are important to consumers, purchasers and health plans. The Narrative also features user-friendly descriptions of each performance measure, plus valuable guidance on interpreting and using HEDIS data.


Order HEDIS 2017 Volume 1:
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Order HEDIS 2016 Volume 1:
Available Now

 

 

HEDIS Volume 2: Technical Specifications for Health Plans


 

A required resource for anyone involved in collecting, calculating or submitting HEDIS data, HEDIS Volume 2 features the complete technical specifications for each measure. It also includes general guidelines for data collection and reporting, detailed instructions on how to perform the necessary calculations and guidelines for sampling.

 

The HEDIS 2017 Value Set Directories (.xlsx) consist of an electronic locked Excel file that is included with the purchase of HEDIS 2017 Volume 2 in print or electronic format. The VSDs are searchable and sortable. VSDs are only available in electronic format; customers who purchase the print version of Volume 2 will receive the measures in print and the VSDs in electronic form.

 

This publication incorporates content from the Centers for Medicaid and Medicaid Services (CMS). For information about the availability of auxiliary aids and services, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.

 

Note: The Volume 2 Technical Specifications for Health Plans publication is used by health plans that report HEDIS data to NCQA. For specifications that are used at the individual physician level, practice site, or medical group level, please see: Technical Specifications for Physician Measurement.
 

Order HEDIS 2017 Volume 2:
Available Now

Order HEDIS 2016 Volume 2:
Available Now

 

 

HEDIS Volume 3: Specifications for Survey Measures


 

HEDIS Volume 3 contains complete instructions for administering all the survey-based HEDIS Measures, including surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program. Specifically, it includes the CAHPS Health Plan Survey, 5.0H Adult Version, CAHPS Health Plan Survey 5.0H Child Version, Medical Assistance with Smoking and Tobacco Use Cessation, Flu Vaccinations for Adults Ages 18-64, Flu Vaccinations for Adults Ages 65 and Older, Pneumococcal Vaccination Status for Older Adults, and Aspirin Use and Discussion. Volume 3 also includes technical specifications, background information, protocols necessary for administering the survey instruments and accompanying correspondence.

 

Order HEDIS 2017 Volume 3:
Available Now

Order HEDIS 2016 Volume 3:
Available Now

 

 

HEDIS Volume 5: HEDIS Compliance Audit™: Standards, Policies and Procedures


 

Health plans must submit audited HEDIS data to achieve NCQA Accreditation and/or meet employer expectations. HEDIS Volume 5 describes in detail the methodology used for auditing a health plan’s data collection programs, calculation processes and HEDIS measure results. This Volume also includes the standards and guidelines for assessing a health plan’s information systems capabilities, and the standards and guidelines used to evaluate a plan’s ability to comply with HEDIS specifications.

 

Order HEDIS 2017 Volume 5:
Available Now

Order HEDIS 2016 Volume 5:
Available Now

 

 

HEDIS Volume 6: Specifications for The Medicare Health Outcomes Survey


 

The Medicare Health Outcomes Survey (HOS) measure was developed to monitor and evaluate the quality of care and service provided to Medicare beneficiaries and grant them information that supports plan-to-plan comparison. HEDIS Volume 6 features details about the measure, the survey instrument and information that health plans and vendors need to report results.

 

Order HEDIS 2017 Volume 6:
Available Now

 

Order HEDIS 2016 Volume 6:
Available Now

 

 

 

HEDIS Technical Specifications for Physician Measurement


 

HEDIS is the most widely used set of inpatient and ambulatory performance measures in the health care industry. HEDIS Technical Specifications for Physician Measurement is the newest addition to NCQA’s suite of HEDIS products. Its purpose is to support standardized measurement by providing the technical specifications necessary to enable reliable, equitable and valid measurement and reporting of physician-specific performance.

 

For HEDIS 2017, all value sets and codes needed to report physician measures will be listed individually in the HEDIS 2017 Physician Measurement Value Set Directories (VSDs) that accompany the Technical Specifications for Physician Measurement publication. The HEDIS 2017 Physician Measurement Value Set Directories (.xlsx) consist of an electronic locked Excel file that is included with the purchase of Technical Specifications for Physician Measurement publication in print or electronic format. The VSDs are searchable and sortable.


Note: The Technical Specifications for Physician Measurement publication contains specifications that are used at the individual physician level, practice site level, or medical group level. For specifications that are used by health plans to report HEDIS data to NCQA, please see: Volume 2: Technical Specifications for Health Plans.

 

Order HEDIS 2017 Technical Specifications for Physician Measurement:
Available Now 

 

Order HEDIS 2016 Technical Specifications for Physician Measurement:
Available Now 

 

 

 

HEDIS Specifications for CAHPS PCMH Survey


 

HEDIS Specifications for CAHPS PCMH Survey contains complete instructions for administering the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) PCMH (Patient-Centered Medical Home) Survey. It includes technical specifications, survey questionnaires, and standardized protocols required for data collection and accompanying correspondence. This publication is intended for survey vendors and organizations interested in administering the survey for the PCMH Distinction in Patient Experience Reporting. More information on the Distinction in Patient Experience Reporting is located here.


Purchase HEDIS 2014 Specifications for CAHPS PCMH Survey:

 

 

Technical Specifications for ACO Measurement


 

A necessary resource for anyone involved in collecting, calculating or submitting HEDIS data for Accountable Care Organizations (ACOs). This publication features general guidelines for data collection and the complete technical specifications for the performance measures referenced in NCQA's Standards and Guidelines for the Accreditation of Accountable Care Organizations. The publication includes detailed instructions on sampling, how to perform the necessary calculations, and all relevant data elements for reporting ACO measure results for accreditation or quality improvement initiatives.


Purchase HEDIS 2016 Technical Specifications for ACO Measurement:

 

2017 Quality Rating System (QRS) HEDIS Value Set Directory


 

This Value Set Directory (VSD) includes value sets and codes needed to calculate and report HEDIS measures included in the 2016 Quality Rating System (QRS).


Download 2017 Quality Rating System (QRS) HEDIS Value Set Directory: