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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 and Medicaid Services uses HEDIS scores to monitor a health plan’s performance. More than 90% of United States health plans use HEDIS scores to compare how well the plan performs in areas like:
- Quality of care.
- Access to care.
- Member satisfaction with the plan and providers.
We’ll coordinate with the other managed care organizations (MCO) on HEDIS measures, such as:
- Ensuring timely and accurate collection and exchange of data.
- Collaborating on HEDIS outcome improvement initiatives.
Assesses children aged six years and older who were hospitalized for treatment of selected mental illness or intentional self-harm and had an outpatient visit, an intensive outpatient treatment visit or a partial hospitalization with a mental health practitioner. The measure identifies the percentage of members who received follow-up within seven days discharge.
CAHPS (Consumer Assessment of Healthcare Providers and Systems) family/youth rating of health plan
These surveys ask patients (or in some cases their families) about their experiences with, and ratings of, their healthcare providers and plans, including hospitals, home healthcare agencies, doctors, and health and drug plans, among others.
Assesses adults and adolescents aged 13 years and older with a new episode of substance use dependence (SUD) dependence who received the following:
- Initiation of SUD treatment: Adolescents and adults who initiated treatment through an inpatient SUD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth or medication-assisted treatment (MAT) within 14 days of diagnosis.
- Engagement of SUD treatment: Adolescents and adults who initiated treatment and had two or more additional SUD services or MAT within 34 days of the initiation visit.
Percentage of members aged 17 years and younger and 18 to 20 years who were treated with antidepressants and had a diagnosis of major depression and who remained on an antidepressant medication treatment.
- Effective Acute Phase Treatment: Members who remained on an antidepressant medication for at least 84 days (12 weeks).
Percentage of members aged 17 years and younger and 18 to 20 years who were treated with antidepressants and had a diagnosis of major depression and who remained on an antidepressant medication treatment.
- Effective continuation phase treatment: Members who remained on an antidepressant medication for at least 180 days (six months).
Follow-up after ED visit for mental illness: seven-day follow-up — reporting only
Members aged six years and older with a principal diagnosis of mental illness or intentional self-harm, who have had an emergency department (ED) visit and need a follow-up visit for mental illness within seven days of the ED visit (eight total days) or 30 days of the ED visit (31 total days).
Follow-up after ED visit for substance use, total 30-day follow-up
The measure focuses on follow-up visits for substance use disorder (SUD) abuse or dependence in members aged 13 years and older after a principal diagnosis of SUD abuse or dependence during an emergency department (ED) visit. Two rates are reported for follow-up visits after an ED visit: within seven days and within 30 days of ED visit.
Use of first-line psychosocial care for children and adolescents on antipsychotics, total
Assesses the percentage of children and adolescents ages one to 17 newly started on antipsychotic medications without a clinical indication who had documentation of psychosocial care as first-line treatment.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).