The healthcare landscape in the US is evolving at a rapid pace, given the rising medical costs and mandates of healthcare reforms. Today, it has become a key imperative for healthcare stakeholders to innovate to meet new market needs.
On the other hand, it is clearly evident that of all the ways technology has improved the lives of humans across the globe, none are as important as the technological advances in healthcare. Especially in recent times, the advancement in healthcare technologies has dramatically improved the care quality, thereby saving more lives and helping people live healthier and longer.
Along with the obvious advancements related directly to the health ailments of the patients, technological advances have also helped healthcare stakeholders to overcome many of the traditional obstacles related to compiling, storing, and sharing healthcare information in an effective manner. The Healthcare Effectiveness Data and Information Set (HEDIS) is one such tool used by a majority of health plans, facilitating effective measurement of performance on important dimensions of care and service.
What Is HEDIS?
HEDIS is the Healthcare Effectiveness Data and Information Set. It is a tool that measures health plan performance. It is focused on collecting, organizing and reporting data about care and service. HEDIS reporting is very important for health plans to understand how they are performing.
All plans using HEDIS report the same measured data sets. Because of this, it allows for accurate comparisons between plans, as well. Some of the measures included are as follows:
- Immunization schedules
- Medication management
- Patient statistics
- Cancer screenings
Having all of this data in one comprehensive report is not only beneficial for plan providers, but it also helps physicians and healthcare facilities to enhance their care quality.
How Does HEDIS Help?
For health plans, HEDIS ratings can be very useful. The scores on the measures can help them understand the quality of care being delivered to their members, especially in case of chronic and acute ailments. Higher HEDIS scores can help the health plans to compete more effectively in different markets. Also the score reporting is often required in public markets, where it’s mandatory to report the results to the states or counties, in which the health plans resides.
The same type of analysis/intervention applies to healthcare providers. Analysis of HEDIS data enables the providers to identify gaps in care, particularly preventive care, especially for high- risk patient populations with chronic health ailments such as diabetes, lung and cardiovascular disorders. The results can also help them identify and address at-risk pediatric populations who fail to complete preventive care such as immunizations and oral care.
As the healthcare industry moves towards value-based purchasing, all the healthcare stakeholders including the providers, health plans and their vendors are increasingly focused on the enhancing the quality of care delivered.
HEDIS reporting is expected to play a key role in such scenario, driving the health plans to maintain a high score across all measures in order to improve patient satisfaction and ensure superior provider performance.