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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:
The percentage of members 18 years of age and older with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.
The percentage of members 3 months of age and older who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. Members can either be seen in an outpatient setting, telephone, online assessment, observation or emergency department (ED) visit that doesn’t result in an inpatient stay with only a diagnosis of URI.
The percentage of 3 years of age and older who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus strep test for the episode. A higher rate represents better performance, i.e., appropriate testing.
Members can either be seen in an outpatient setting, telephone, online assessment, observation or ED visit. Observation or ED visits that result in inpatient stays are not included in the measure.
The percentage of members 18 to 64 years of age with schizophrenia, schizoaffective disorder or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).