HEDIS MY 2020 & MY 2021 Draft FHIR Digital Measures (5 Measures)

• Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
• Cervical Cancer Screening (CCS)
• Childhood Immunization Status (CIS)
• Immunizations for Adolescents (IMA)
• Non-Recommended PSA-Based Screening in Older Men (PSA)

NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs. HEDIS is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance.

The tables below explain the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures for two types of care: preventive health care (children and adolescents, women and adolescent girls, adults, and seniors) and condition-specific care.

What are the 5 domains of hedis?

• Effectiveness of Care.
• Access/Availability of Care.
• Experience of Care.
• Utilization and Risk Adjusted Utilization.
• Health Plan Descriptive Information.
• Measures Collected Using Electronic Clinical Data Systems.

The transition will coincide with the HEDIS Timeline transition process starting in HEDIS 2020 and completing in 2021.

NCQA accreditation: What does it mean? The National Committee for Quality Assurance (NCQA) accredits and certifies an array of healthcare organizations, including providers, practices and health plans. The non-profit organization began in the early 1990s by measuring and then accrediting health plans.

The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. We work for better health care, better choices and better health.

NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers.

NCQA standards are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Standards evaluate plans on: Quality Management and Improvement.

NCQA gives consumers the information they need to find high-quality health care. We do this by measuring the quality of practices, providers, health plans and other health care organizations. We share our information broadly, at no cost to the general public.

All Medicare plans required by CMS to submit HEDIS are included in the published ratings. Medicare plans that are not required by CMS to submit HEDIS are not included in the published ratings unless they have earned NCQA Accreditation.

For Individuals: How to Become a Certified HEDIS Compliance Auditor

1. Request an Application. Submit an inquiry through My NCQA.
2. Review Handbook and Application.
3. Submit Your Application.
4. NCQA Approves Your Application.
5. Learn Requirements and Audit Process.
6. Sit for Your Exam.

Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives.

NCQA collects HEDIS data from health plans and other health care organizations. Audits protect results’ validity and reliability. NCQA screens, trains and certifies organizations that collect or audit data for health plans and providers. Accountable health care requires both measurement and transparency.

HEDIS – NCQA HEDIS and Performance Measurement 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. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through MyNCQA.

The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. NCQA’s HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications. Visitors to this page often check HEDIS FAQs or ask a question through MyNCQA.