Which group sponsors the healthcare effectiveness data and information set hedis?

You can use two well-established health plan measurement sets as the basis for collecting data and preparing comparative information for your audience:

• Healthcare Effectiveness Data and Information Set (HEDIS)
• CAHPS Health Plan Survey (CAHPS stands for Consumer Assessment of Healthcare Providers and Systems)

These measures have been endorsed by the National Quality Forum, a multistakeholder organization established to standardize health care quality measurement and reporting. Learn about the National Quality Forum.

HEDIS®

HEDIS refers to a widely used set of performance measures in the managed care industry. More than 90 percent of health plans—HMOs, POS plans, and PPOs—use HEDIS to measure performance. HEDIS is managed by the National Committee for Quality Assurance (NCQA), a private, non-profit organization that accredits and certifies health care organizations. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. Learn about the NCQA.

HEDIS enables consumers and purchasers to compare health plan performance to other plans and to national or regional benchmarks. Consisting of over 70 measures of process, structure, and outcomes, HEDIS addresses a spectrum of care from prevention to acute to chronic care. It also encompasses health plan members’ assessments of their experiences with care as measured by the CAHPS Health Plan Survey (described below). NCQA adds, deletes, and revises HEDIS measures annually.

HEDIS scores are regarded as highly credible, in part because an NCQA-approved auditing firm must validate results. Also, an NCQA-approved external survey organization must administer the CAHPS survey when it is part of a health plan’s HEDIS submission to NCQA.

Data source: You can obtain HEDIS results directly from health plans or by purchasing access to NCQA’s Quality Compass® database of health plan performance results. More details about Quality Compass are provided in Databases Used for Health Plan Quality Measures. For more information about HEDIS or to purchase HEDIS publications, visit NCQA’s Web site at https://www.ncqa.org.

CAHPS® Health Plan Survey

CAHPS refers to a family of standardized surveys that can be used to gather and report information on consumers’ experiences with health plans and providers. The surveys are developed and supported by a consortium of researchers with funding from the Agency for Healthcare Research and Quality (AHRQ).

The CAHPS Health Plan Survey consists of over 40 items that ask the respondent to rate their experiences with different aspects of care, including access, timeliness, communication, courtesy, and administrative ease. Instruments are available for adults and children in commercial, Medicaid, and Medicare populations.

Data source: Some sponsors generate CAHPS data by surveying their own audiences (e.g., employees, beneficiaries); however, sponsors typically get this information directly from the health plans or from NCQA because results from this CAHPS survey are incorporated into HEDIS. For more information about the survey, visit the CAHPS website.

Because physician-level measurement sets were introduced relatively recently—and some are still in development—they have not yet been widely implemented by report card sponsors. The measure sets listed here have been endorsed, in whole or in part, by the National Quality Forum (NQF), an organization established to standardize healthcare quality and reporting.

HEDIS®

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry. Implemented in the early 1990s to measure health plan performance, HEDIS incorporated physician-level measures in 2006. HEDIS is managed by the National Committee for Quality Assurance (NCQA), a private, non-profit organization that accredits and certifies healthcare organizations.

HEDIS measures of physician quality address:

• The effectiveness of care.
• Access to care.
• The use of services.

Most of the measures of physician quality are adapted from HEDIS indicators commonly reported at the health plan level. They can be used to assess performance at the individual, practice site, or medical group level. Many of the measures have NQF's endorsement.

Learn more about HEDIS measures.

Core Quality Measures Collaborative

The Core Quality Measures Collaborative (CQMC) is a multi-stakeholder coalition of healthcare organizations first convened by America's Health Insurance Plans (AHIP) in 2015. Their goal was to work together to recommend core sets of quality measures by clinical area for use in alternative payment models.

Review the CQMC's eight core sets of quality measures for primary and specialty care.

CAHPS® Clinician & Group Survey

CAHPS, or the Consumer Assessment of Healthcare Providers and Systems, refers to a set of standardized surveys that can be used to gather and report information on consumers’ experiences with providers and health plans.

The CAHPS Clinician & Group Survey assesses the experiences of patients with physicians and their office staff; specifically, the measures cover:

• Getting timely appointments, care, and information.
• How well providers communicate with patients.
• Providers' use of information to coordinate patient care.
• Helpful, courteous, and respectful office staff.
• An overall rating of the provider.

Questionnaires are available for adults or children receiving primary or specialty care. Optional supplemental items can be used to gather additional information about patients' experiences with care.

Users can field these questionnaires to obtain information on group practices, sites of care, individual clinicians, or provider networks.

Medicaid's Core Sets of Quality Measures

Under the Affordable Care Act, the Department of Health and Human Services (HHS) must collect and publish healthcare quality measures for adult and child enrollees in Medicaid. States can collect data for two sets of measures, many of which can be used for physician practices or groups:

• 2019 Adult Core Set
• 2019 Child Core Set

Learn more about performance measurement in the Medicaid program.

Physician Consortium for Performance Improvement®

The Physician Consortium for Performance Improvement® (PCPI) is a national initiative leading the development, testing, and maintenance of evidence-based clinical performance measures and measurement resources for physicians.

PCPI and its members have developed more than 350 measures of physician-level clinical performance measures, many of which are endorsed by NQF and used to support federal programs.

Review directories of measures stewarded by PCPI and measures stewarded by its partners in measure development.

Other Sources of Clinical Measures

Other sources of measures include physician specialty societies (e.g., American College of Surgeons) and disease-focused organizations (e.g., American Diabetes Association). Many of these organizations—too numerous to list here—have created measures addressing clinical quality issues specific to a particular specialty or health condition. Some of these measures may be included in the PCPI initiative described above. Visit the Web sites of each organization for more information.

Which group sponsors the Healthcare Effectiveness Data and Information Set HEDIS )?

Who collects data for HEDIS?

Which of the following groups sponsors the National Guideline Clearinghouse?

What is measured by the Healthcare Effectiveness Data and Information Set?