The Healthcare Effectiveness Data and Information Set (HEDIS®) is one of health care's most widely used performance improvement tools. 191 million people are enrolled in plans that report HEDIS results.

HEDIS measures performance in health care where improvements can make a meaningful difference in people's lives. 
 

HEDIS Reporting Period: HEDIS season is a small window of time annually during the spring (February to May). Charts requested are used for assessment of management of chronic health conditions and wellness screenings. We ask providers’ offices to submit records in a timely fashion to assure a successful HEDIS season. Data abstracted from clinical records are reported to NCQA, CMS and linked to Align. Measure. Perform. (AMP) – an Integrated Health Association (IHA) sponsored collaborative.

Effectiveness of Care

The “Effectiveness of Care” measures are categorized as follows: 

Prevention and Screening

• Childhood Immunization Status
• Immunizations for Adolescents
• Breast Cancer Screening
• Cervical Cancer Screening
• Colorectal Cancer Screening
• Chlamydia Screening in Women
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children
• Follow-up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions
• Care for Older Adults

Respiratory Conditions

• Use of Spirometry Testing in the Assessment and Diagnosis of COPD
• Pharmacotherapy Management of COPD
• Asthma Medication Ratio
• Appropriate Testing for Pharyngitis

Cardiovascular Conditions

• Controlling High Blood Pressure
• Persistence of Beta-Blocker Treatment After a Heart Attack
• Cardiac Rehabilitation
• Statin Therapy for Patients with Cardiovascular Disease

Musculoskeletal Conditions

• Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
• Osteoporosis Management in Women Who Had a Fracture
• Osteoporosis Screening in Older Women

Diabetes 

• Comprehensive Diabetes Care: HbA1c Control (<8.0%); Diabetic Retinal Eye Exam; BP Control <140/90
• Kidney Health Evaluation for Patients with Diabetes
• Statin Therapy for Patients with Diabetes

Behavioral Health

• Antidepressant Medication Management
• Follow-Up After Hospitalization for Mental Illness
• Follow-Up Care for Children Prescribed ADHD Medication
• Pharmacotherapy for Opioid Use Disorder

Medication Management and Care Coordination

• Transitions of Care
• Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions
• Overuse/Appropriateness: Use of Opioids
  • High Dosages
  • Risk of Continued Opioid Use > 15 Days
• Appropriate Treatment of Children with URI
• Avoidance Antibiotics–Adults with Bronchitis
• Use of Imaging for Low Back Pain
• Non-Recommended PSA-Based Screening in Older Men
• Use of High-Risk Medications in Older Adults
• Potentially Harmful Drug-Disease Interactions in Older Adults
• Use of High-Risk Medications in Older Adults

Access/Availability of Care

• Timeliness of Prenatal Care
• Timeliness of Postpartum Care
• Initiation and Engagement of Alcohol & Other Drug Dependence Treatment
• Use of First-Line Psychosocial Care for Children & Adolescents on Antipsychotics