HEDIS Publications: Overview

 

    

 
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 Long-Term Services and Supports Measurement

Technical Specifications for ACO Measurement

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 2020 Volume 1:
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Order HEDIS 2019 Volume 1:
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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 about how to perform the necessary calculations and guidelines for sampling.

 

HEDIS 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. 

 

HEDIS 2020 Volume 2 incorporates the following additional content, providing added value to our customers:

 
Rules for Allowable Adjustments of HEDIS: HEDIS measures, used by a variety of health system organizations and stakeholders, meet rigorous development and evaluation criteria, and their correct use allows for building benchmarks and comparison among specific organizations. Recognizing that HEDIS measures have traditionally been specified for health plan reporting, and that the industry desires to apply the measures to different levels of the health care system to facilitate, for example, population health management and quality improvement, NCQA incorporated the “Rules for Allowable Adjustments of HEDIS,” (the “Rules”) into HEDIS Volume 2. The Rules describe an approach and prescribe guidelines for adjusting NCQA’s HEDIS measure specifications for use with other populations. The Rules were reviewed and approved by NCQA measure experts and provide room for evaluating alternate populations without changing the clinical intent of the measure or infringing on NCQA’s copyrighted intellectual property.

 

HEDIS 2020 Value Set Directory (VSD): The HEDIS 2020 VSD now includes additional third-party codes, which can be used for HEDIS measure results and results stemming from adjusted measure specifications based on the Rules. The HEDIS 2020 Value Set Directory (VSD) consists of a locked Excel file (.xlsx) that is made available with the purchase of HEDIS 2020 Volume 2 in print or electronic format. The HEDIS VSD is searchable and sortable. The HEDIS VSD is available in electronic format only; customers who purchase the print version of HEDIS Volume 2 will receive the measures in print and the HEDIS VSD in electronic form. 

 

Note: ECDS (Electronic Clinical Data Systems) measures in digital format are not included with the HEDIS 2020 Volume 2 publication. HEDIS 2020 ECDS measures are only available by purchasing one of the following products:

 

Order HEDIS 2020 Volume 2:
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Order HEDIS 2019 Volume 2:
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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 2020 Volume 3:
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Order HEDIS 2019 Volume 3:
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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 2020 Volume 5:
Anticipated Release Date: October 2019

Order HEDIS 2019 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 2020 Volume 6:
Anticipated Release Date: February 2020

Order HEDIS 2019 Volume 6:
Available Now

 

 

HEDIS Technical Specifications for Long-Term Services and Supports Measurement


 

HEDIS 2020 Technical Specifications for Long-Term Services and Supports Measures is a new set of Healthcare Effectiveness and Data Information Set (HEDIS®) measures designed to assess whether organizations providing or coordinating long-term services and supports (LTSS) are delivering high-quality, person-centered care. The set of four measures evaluates quality of assessment, care planning and care coordination for organizations providing LTSS. This measure set will facilitate the creation of performance standards, allow for comparison of LTSS quality across programs, and establish national benchmarks.

 

Order HEDIS 2020 Technical Specifications for LTSS Measurement:
Anticipated Release Date: September 2019

Order HEDIS 2019 Technical Specifications for LTSS Measurement:
Available Now

 

 

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. 

 

Order HEDIS 2019 Technical Specifications for ACO Measurement:
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Order HEDIS 2018 Technical Specifications for ACO Measurement:
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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 Quality Rating System (QRS).

 

Order 2020 Quality Rating System (QRS) HEDIS Value Set Directory:
Anticipated Release Date: September 2019

Order 2019 Quality Rating System (QRS) HEDIS Value Set Directory:
Available Now