With a lot of technological advancements within the last decade, the change in healthcare industry has become very rapid and the demands and requirements to keep up with this pace is also increasing. Now a days there is so much diversity and options available in healthcare industry that a need to measure or compare health care plans is very much necessary and it has become possible due to HEDIS.
HEDIS stands for Healthcare Effectiveness Data and Information Set. It is developed as a tool which is so effective that it has been used by more than 90 percent healthcare plans in America.
HEDIS was first introduced in 1980s and after few years it was entrusted to NCQA and now HEDIS is NCQA’s accreditation component. Through the years i.e. from early 90s to 2007, different versions of HEDIS have been introduced by NCQA but in 2007 NCQA declared its name which is currently in use and defines its role well and it is now a registered trademark of NCQA which stands for national committee for quality assurance.
HEDIS has 81 measures in 5 different domains. These domains are:
1. Utilization and Relative Resource Use
2. Access/Availability of Care
3. Experience of Care
4. Effectiveness of Care
5. Health Plan Descriptive Information
Each year NCQA introduces a new version of HEDIS which contains certain changes in its measures. In order to develop HEDIS measures multiple steps are being involved. This process to form measures consider the attributes of being feasible, reliable and validate able. By developing new measures of HEDIS this thing is kept in mind that it’s desirable or not e.g. whether developing a new measure or use an existing one defining what makes a measure desirable is very important. Desirable might seem a very wishful word but it’s really necessary because the measure should serve at its best. While developing measure it is considered that how relevant it is e.g. will the measure can contribute in quality improvement? Measure has to be scientifically strong and it has to be affordable both in terms of its cost and usage i.e. it’s easy to use. From the development to the retirement of a measure it has a life cycle. The latest version is HEDIS 2016.
HEDIS also supports or compatible with the ECDS (Electronic Clinical Data System). ECDS is a way of reporting which focuses on collaborative system of care and it has also been shown in the diagram below.
Another important aspect here is that in electronic data system the role of EHR (Electronic Health Records) is very significant.
HEDIS has also faced criticism as in its early phase of development it was described as a controversial. Other criticisms included that: but not limited to:
• HEDIS measures do not account for many important aspects of health care quality
• Attempts by health care providers to improve their HEDIS measures may cause harm to patients
• The process to develop HEDIS measures may be flawed
• In some cases, attainment of HEDIS measures is not proven to be associated with better health outcomes
HEDIS measures address a broad range of important health issues. Among them are the following: Asthma Medication Use, Persistence of Beta-Blocker Treatment after a Heart Attack, Controlling High Blood Pressure, Comprehensive Diabetes Care, Breast Cancer Screening, Antidepressant Medication Management, Childhood and Adolescent Immunization Status, Childhood and Adult Weight/BMI Assessment. Since the switching of ICD-9 to ICD-10 NCQA created a plan to identify an effective and suitable set of ICD-10 codes for each HEDIS measure. NCQA has expanded the possibility of HEDIS from a thin collection of process measures to a broad set that measures a range of important health care interventions and results. The existing HEDIS set addresses preventive services, chronic disease management, behavioral health care, appropriateness/overuse of services and value. HEDIS includes measures for high-burden diseases such as diabetes, asthma, heart disease and depression, as well as preventable hospitalizations and patient satisfaction.
By HEDIS health system put great emphasis on the HMO’s to increase the incentive for the doctors if they comply with the measures of HEDIS and through this the medical facilities take better care of their patients which improve the overall health quality of the patients. Through this the healthcare system demands that the health problems in the population should be minimized if not eliminated and the coverage for the health care.
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