HEDIS 2019 Volume 2 (epub)
HEDIS 2019 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.
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.
The HEDIS 2019 Value Set Directories (“VSD”) (.xlsx) consist of an electronic locked Excel file that is included with the purchase of HEDIS 2019 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.
The HEDIS measures and specifications contained in HEDIS Volume 2 publication were developed by and are owned by NCQA. Unauthorized internal distribution of the publication and materials therein—beyond the number of users licensed by your organization—is prohibited. Anyone desiring broader internal distribution of HEDIS Volume 2 must purchase additional licensed user permissions via the NCQA Store.
An organization’s licensed users may use the materials solely for an internal non-commercial purpose without obtaining NCQA approval. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications and/or VSD into any product or service to calculate measure results for customers for any purpose) and/or any external reproduction, distribution or publication (including but not limited to federal and state entities using or incorporating the measures into their programs) must be approved by NCQA and are subject to a license at the discretion of NCQA.
Anyone contemplating a commercial use, or external reproduction, distribution or publication of any part of Volume 2, should not purchase HEDIS Volume 2 via the NCQA Store, and must contact the NCQA licensing team by submitting a request through https://my.ncqa.org to discuss the need for a license.
In addition to the traditional measure specification content offered in Volume 2, HEDIS 2019 Volume 2 will also include 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 has produced a supplement to HEDIS Volume 2, the “Rules for Allowable Adjustments of HEDIS®,” (the “Rules”) that describes an approach and prescribes 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 Adjustments Value Set Directory: Users of the 2019 Rules for Allowable Adjustments of HEDIS will need to use the separate, unique HEDIS Value Set Directory (VSD) for Allowable Adjustments of HEDIS (the “HEDIS Adjustments VSD”) to enable calculation of measure results stemming from adjusted measure specification based on the Rules.
Anyone desiring to use the HEDIS Adjustments VSD without modification solely for an internal non-commercial purpose may do so without obtaining any approval from NCQA. All other uses, including a commercial use and/or external reproduction, distribution or publication must be approved by NCQA and are subject to a license at the discretion of NCQA.
Note: The HEDIS Adjustments VSD should be used in conjunction with the Rules for Allowable Adjustments of HEDIS. The HEDIS Adjustments VSD may NOT be used to assist in calculating HEDIS measure results for health plan reporting to NCQA.
Digital Measure Packages: NCQA is providing, for this year’s HEDIS release, free of cost, six new Digital Measure Packages that represent the beginning of HEDIS Electronic Clinical Data System (ECDS) Reporting. These six new packages represent digital formats of the HEDIS ECDS measures, which allow them to be directly consumed by the reporting system. All the files within each digital measure are packaged together to include both the human readable technical documentation and the machine-readable files necessary for implementation. Each HEDIS ECDS digital measure package includes the following files: Human Readable pdf, Clinical Quality Language (CQL), XML, JSON, HQMF, and NCQA Common Library files. For a detailed description of the files, refer to ECDS General Guideline 6: HEDIS ECDS Digital Measure Format.
Note: The October updates—as listed in the Technical Specifications Update document on the NCQA website—are not automatically incorporated into the standard HEDIS Volume 2 publication. A Volume 2 epub with October updates incorporated is made available only to members of the HEDIS User Group (HUG) as a membership incentive, and may be obtained by purchasing a HUG membership publication package. You can find more information about HUG membership here and purchase it through the NCQA Store here.