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What is HEDIS used for?
The National Committee for Quality Assurance (NCQA) coordinates HEDIS testing and scorekeeping. The Centers for Medicare & Medicaid Services uses HEDIS scores to monitor a health plan’s performance. HEDIS scores are used by more than 90% of American health plans to compare how well the plan performs in areas like:
- Quality of care
- Access to care
- Member satisfaction with the plan and providers
HEDIS education materials
Here are some helpful links to get started with:
HEDIS tips for primary care physicians (PDF)
HEDIS tips for pediatricians (PDF)
Childhood immunization status, combo 3 (CIS C3)
The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); four pneumococcal conjugate (PCV) vaccines by their second birthday.
Immunizations for adolescents, combo 2 (IMA C2)
The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday.
Cervical cancer screening (CCS)
The percentage of women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
- Women 21–64 years of age who had cervical cytology performed within the last three years.
- Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last five years.
- Women 30–64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) cotesting within the last five years.
Colorectal cancer screening (COL)
The percentage of members 50–75 years of age who had appropriate screening for colorectal cancer.
Comprehensive diabetes care, HbA1c poor control (CDC >9)
The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had a HbA1c test with a result >9. This is a reverse measure; a lower rate is better.
Controlling high blood pressure (CBP)
The percentage of members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year.
The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit for AOD within 30 days.
Follow-up after emergency department visit for mental illness within 30 days (FUM)
The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness within 30 days.
Follow-up after hospitalization for mental illness within 30 days (FUH)
The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider within 30 days.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).