HJNO Nov/Dec 2023

44 NOV / DEC 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS COLUMN MEDICAID and evaluate levels of access to care that patients need. Altogether, HEDIS consists of 92 measures across six domains of care: 1. Effectiveness of care. 2. Access/availability of care. 3. Experience of care. 4. Utilization and risk adjusted utilization. 5. Health plan descriptive information. 6. Measures reported using electronic clinical data systems. To reflect the changing priorities and needs of the healthcare community, NCQA updates the HEDIS data composition each year. In 2023, NCQA added and adjusted the HEDIS measures to put additional em- phasis on arguably one of the most essen- tial goals facing the modern era: health eq- uity. Designed to collect better data across several key categories, including the social determinants of health, the changes ad- dress access to dental care, the appropri- ate clinical treatment of elderly individu- WHENTHE National Committee for Qual- ity Assurance (NCQA) introduced HEDIS measures in 1991, they were called the “HMO Employer Data and Information Set.” Originally, HEDIS was created with the goal of providing information for use with comparing managed care plans’ ef- fectiveness — namely, health maintenance organizations (HMOs). Today, HEDIS stands for “Healthcare Effectiveness Data and Information Set” and has emerged as the known and accepted standard for quantifying plan performance. Represent- ing more than 200 million plan members, HEDIS results are used by more than 90% of Medicaid, Medicare, and commercial health plans to objectively measure and track their annual performance. HEDIS measures are calculated using data from administrative claims, clinical EHR (elec- tronic health records), and patient feed- back collected from CAHPS (Consum- er Assessment of Healthcare Providers and Systems) surveys as well as from the Medicare Health Outcomes survey. HEDIS data shape significant areas of healthcare and risk adjustments, determine health plan ratings and performance, assess pay-for-performance provider arrange- ments, and inform population health im- provement initiatives. HEDIS measures and what they include HEDIS quality measures give insights into how well appropriate care is being provided as well as member perceptions of care. For example, measures show whether, and to what extent, regular can- cer screenings and preventive care visits occur; if high blood pressure is controlled appropriately; and whether heart disease, diabetes care, mental health, asthma, and other medical conditions are managed well. They also monitor screenings for al- cohol use, smoking cessation assistance, PERFORMANCE MANAGEMENT: Measuring Quality of Care