HEDIS^® Healthcare Effectiveness Data Information Set

What is HEDIS?

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a set of nationally standardized measures commonly used in the managed care industry to measure a health plan’s performance during the previous calendar year. The measures were developed by the National Committee for Quality Assurance (NCQA) and are updated annually.

The State of Missouri requires Missouri Care to report specific measures yearly to the Department of Health and Senior Services (DHSS) and to the MO HealthNet Division. Measures are also subject to a national audit and reported to NCQA.

Measures
Missouri Care reports annual HEDIS rates for the following measures:

• Effectiveness of Care – assesses the delivery of preventive care services and services related to chronic disease
• Childhood Immunizations
• Cervical Cancer Screening
• Chlamydia Screening in Women
• Use of Appropriate Medications for People with Asthma
• Follow-up After Hospitalization for Mental Illness
• Access/Availability of Care – assesses the availability of health care to plan members
• Prenatal and Postpartum Care
• Annual Dental Visit
• Satisfaction with the Experience of Care – measures member satisfaction
• Use of Service – addresses utilization measures, such as discharge rates and average length of stay
• Well-Child Visits in the First 15 Months of Life
• Well-Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life
• Adolescent Well-Care Visits
• Ambulatory Care
• Behavioral Health Utilization – Percentage of Members Receiving Inpatient & Intermediate Care & Ambulatory Services
• Identification of Alcohol and Other Drug Services

HEDIS Process

Some HEDIS measures allow a health plan to attempt to increase rates by supplementing claims data with data obtained from member medical records. Each spring, Missouri Care’s Quality Management staff contacts provider offices to conduct medical record review as part of the HEDIS process. Staff will call the provider office to schedule an in-office review of records on a sample of Missouri Care members. Prior to the review, staff will fax to the provider a list of Missouri Care members for whom records should be pulled for the in-office review. On the review date, staff will review the records in the provider office and make copies of relevant information from the records (Missouri Care will provide the copy paper).