What is HEDIS used for?
The National Committee for Quality Assurance (NCQA) coordinates HEDIS testing and scorekeeping. The Centers for Medicare & Medicaid Services uses HEDIS scores to monitor a health plan’s performance. HEDIS scores are used by American health plans to compare how well the plan performs in areas like:
- Quality of care
- Access to care
- Member satisfaction with the plan and providers
HEDIS education materials
Here are some helpful links to get started with:
- Provider training videos
- Other training webinars and videos
- HEDIS reference tool (PDF)
- HEDIS tips for primary care physicians (PDF)
- HEDIS tips for pediatricians (PDF)
- HEDIS training webinar series (PDF)
- HEDIS 101 & CAHPS survey training
HEDIS measures
Adherence to antipsychotic medications for individuals with schizophrenia (SAA) (PDF)
The percentage of members 18 years of age and older with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.
Appropriate treatment for upper respiratory infection (URI) (PDF)
The percentage of members 3 months of age and older who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. Members can either be seen in an outpatient setting, telephone, online assessment, observation or emergency department (ED) visit that doesn’t result in an inpatient stay with only a diagnosis of URI.
Appropriate testing for pharyngitis (CWP) (PDF)
The percentage of 3 years of age and older who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus strep test for the episode. A higher rate represents better performance, i.e., appropriate testing.
Members can either be seen in an outpatient setting, telephone, online assessment, observation or ED visit. Observation or ED visits that result in inpatient stays are not included in the measure.
The percentage of members 18 to 64 years of age with schizophrenia, schizoaffective disorder or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test.
Depression screening and follow-up (PDF)
Depression screenings are an essential component of every primary care visit. They ensure providers care for the whole person – not just physical symptoms. Many people may not realize they are experiencing depression or may feel hesitant to bring it up themselves.
Regular screenings help identify concerns early, before symptoms worsen and begin to affect daily life. Discussing depression with patients normalizes mental health conversations and reduces stigma. When a screening is positive, providers have a responsibility to connect members with appropriate resources and supports, and to continue monitoring their well -being over time.
Unhealthy alcohol use screening and follow-up
Unhealthy alcohol use is a major preventable cause of illness, injury, and death in the U.S. To improve outcomes and meet quality standards, we ask for your continued commitment to annual standardized alcohol screening and timely follow-up (PDF) for patients who screen positive.
The U.S. Preventative Service Task Force (USPSTF) recommends screening all adults 18+ for unhealthy alcohol use and providing brief behavioral counseling, after positive screens. Early identification and brief intervention are proven to reduce harmful drinking and improve patient health.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).