HEDIS Quality Scores Explained

HEDIS Stands for the Healthcare Effectiveness Data and Information Set. It is Created and by the NCQA, Which is the National Committee on Quality Assurance.
HEDIS and NCQA Measure 412 Medicare Advantage Plans, 171 Medicaid Managed Care Plans and 438 Commercial Insurance Plans.
There are 90 HEDIS Measures Ranging from 1) Mammography Screening Rates to 2) Beta Blocker Usage Rates for Patients with Heart Attacks to 3) Diabetes and Hypertension Outcomes Measures.
HEDIS is a Measure of HEALTH PLAN Quality, Even Though it is the Hospitals, Doctors and Nurses that are Actually Responsible for the Quality.
Therefore, in a Large PPO Network, the Aggregate Health Plan Score May Not Be Helpful Because the Individual Quality of Each Provider Gets Mixed Together.
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[@divik28]

I watch all your videos in a healthcarez. Like your no nonsense style. Videos are always to the point and very informative, unlike lot of content on RUclips which is promotional in nature. Keep up the good work of making these videos.

[@ericbricker3440]

Thanks so much for the feedback. Appreciate you watching!

[@patriciareid5230]

Being in this space for many years it may be difficult to ascertain a specific provider quality however many plans provide provider ratings within their directory which is derived by various HEDIS rates at the provider level. Also, although the plan does not manage HEDIS measures directly, they are instrumental in managing networks, providing doctors with non-compliant members and managing payment structures that incentivize provider reimbursement on quality outcomes.

[@drjackburke]

Great energy and well spoken. We need Healthcare for all. Healthcare is a huge business. Disgusting.

[@ahealthcarez]

Thank you for watching and sharing your thoughts.

[@MaheshKamat]

Appreciate and admire your videos. Clear,, educational, and foundational. Thank you Dr. Bricker!

[@ahealthcarez]

Thank you for watching!

[@krunalpatel4683]

Good overview, however one clarification NCQA does not assign Star Ratings - CMS does and CMS allows 5 Stars Plans to enroll year-round. NCQA is just the organization that provides the tools (i.e., HEDIS) to measure quality of care.

[@ahealthcarez]

Thank you. Appreciate you watching.

[@k29lee]

Thank you Dr. Bricker! Amazing videos!

[@ahealthcarez]

Thank you for your kind feedback. Appreciate you watching!

[@sandiwetenkamp3646]

I have been following Dr. Eric Bricker for many years. He is informative, provides food for thought, and provides me with hours of follow research to know more! Thank you Dr. Bricker!

[@ahealthcarez]

Thank you for watching and for your kind feedback.

[@simplysunshine30215]

Greatly explained as a nurse.Straight to the point in less than ten minutes. Impressive

[@ahealthcarez]

Thank you for watching and for your feedback.

[@sharleneacheronti8770]

Thank you so much for explaining this so simply & clear. I love your positive energy too.

[@ahealthcarez]

Thank you for watching and for your kind words.

[@gladysparedes8609]

Great explanations. I am looking forward to get into ambulatory care administration. This information is helpful to understand better HEDIS scores. Thanks.

[@ahealthcarez]

Thank you for watching and for your feedback.

[@evolving3657]

You did a damn good job!!!!

[@ahealthcarez]

Thank you for your feedback.

[@VanessaVasquez09]

thanks for this video!

[@ahealthcarez]

Thank you for watching!!

[@anthonypuglisi3557]

Very informative and great job explaining this.

[@ahealthcarez]

Thank you for your feedback.

[@RaminR]

Great video as always Eric! is Hedis only in primary care or does every specialty have it ?

[@ahealthcarez]

It evaluates health insurance plans including the primary care and specialist care that occurs for plan members. Thank you for your question.

[@aditiarora75]

Very informative.

[@ahealthcarez]

Super! Thank you Aditi!!

[@whiteowl8594]

Can you make videos about the Star measures, CAHPS and HOS surveys?

[@ahealthcarez]

Great suggestions. Thank you!!

[@DrineThePoet]

Excellent video thank you

[@ahealthcarez]

Thank you for watching!!

[@DataWizardry]

Thanks for your explanation. I'm a data analyst in healthcare, trying to make sense of the finance side of healthcare.
What I'm wondering is, suppose a particular hospital on a plan was really poor on a number of measures. What are the consequences? Does the plan say "Hmm.. Hospital A is really bad at these measures, we're going to reimburse them less/drop them from the plan"?
Does the hospital pay a lot of attention to HEDIS measures?
Thanks!

[@ahealthcarez]

Great question. For the most part… No.
The onus is on the Medicare Advantage insurance plan to drop the bad hospital or physician practice from its network if it is dragging downs it’s HEDIS scores.

[@deesee3622]

does anyone have the code for how to do the various HEDIS measures? cant believe I cant find it anywhere

[@kaushikrathod1394]

Hi, good overview, i request you to make video of hedis specs understanding, thank you

[@ahealthcarez]

Thank you for watching and for your suggestion.

[@hemantkhairnar5143]

Thanks for valuable information, just wanted to know what are job opportunities in US, I have 4 years of experience in HEDIS. Thanks in advance!

[@ahealthcarez]

That I do not know. Appreciate you watching.

[@ashleyleonard94]

Thank you for this video!! I was trying to understand what this is am google was being too vague for me

[@ahealthcarez]

Thank you for watching.

[@noahgeberer4110]

Thank you for posting this
Can you talk about the source of this data (ehr, claims, etc) and how it makes its way to ncqa for analysis

[@ahealthcarez]

Great question. Claims.
Thank you for watching and for your question.

[@andieldercraniosacralthera6840]

I learned a lot about claims and the insurance company doesn’t tell you

[@NursetalkwithSheka]

Can you make videos to help quality nurses that work along with these providers come up with strategies that can help them increase their star ratings? I’m struggling in this area it feels like I am running out of ideas

[@ahealthcarez]

Physician behavior has historically been changed through peer pressure… posting results by name across physician for all to see.

[@seanchang5372]

Can you do another video on this?

[@ahealthcarez]

Thank you for watching and for your question.

[@nguyenminhduc1993]

Can you do more about Medicare Star Ratings?

[@ahealthcarez]

Thank you for your suggestion.

[@benjamingold3827]

438 is actually too low. If you use the claims clearinghouse address / ID as the distinct representation of how many plans exist, you're over 10,000.

[@ahealthcarez]

Hi Benjamin, Thank you for watching the video and weighing in.

[@kendrawyatt1441]

Effective? With the most expensive and worst maternal outcomes in the industrialized world, what has HEDIS accomplished? Measuring quality on claims vs clinical data further perpetuates fee for service reimbursement which is literally killing us. Plans and NCQA have little incentive to change the status quo. Employers and CMS/CMMI demand better. Eric look forward to future comments on the switch to measuring quality based on clinical vs claims data.

[@ahealthcarez]

Great point. Claims are not the way to go, IMO.

[@debyoung2913]

This doctor is pretty obnoxious!