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Healthcare Effectiveness Data and Information Set (HEDIS)

Guidance for Healthcare Effectiveness Data and Information Set measures specifically for Special Needs Plans.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 22, 2016

HEDIS Measures

CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS®) measures from Medicare Special Need Plans (SNPs). The HEDIS measurement set is sponsored, supported and maintained by NCQA. Measures relate to many significant public health issues such as cancer, heart disease, behavioral health and diabetes.  SNPs can use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement and provide a set of measurement standards that allow comparison with other plans. HEDIS data help identify performance gaps and establish realistic targets for improvement.

SNPs have reported the following measures since HEDIS Measurement Year (MY) 2016:

  • Colorectal Cancer Screening
  • Care for Older Adults
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  • Pharmacotherapy Management of COPD Exacerbation
  • Controlling High Blood Pressure
  • Persistence of Beta-Blocker Treatment After a Heart Attack
  • Osteoporosis Management in Women Who Had a Fracture
  • Antidepressant Medication Management
  • Follow-Up After Hospitalization for Mental Illness
  • Potentially Harmful Drug-Disease Interactions in  Older Adults
  • Use of High-Risk Medications in  Older Adults
  • Transitions of Care (Reporting began in HEDIS MY 2020)
  • Plan All-Cause Readmissions

Please see the link below for the most recent SNP HEDIS Performance Report.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.