Understanding HEDIS®: Measuring Healthcare Quality and Performance

Data-driven decision-making is essential for improving healthcare outcomes. One of the most important tools for assessing healthcare performance is HEDIS: the Healthcare Effectiveness Data and Information Set. Used by health plans and providers nationwide, HEDIS ensures that patients receive high-quality, evidence-based care while helping organizations meet regulatory requirements and improve operational efficiency.

How Does HEDIS Work?

HEDIS collects data from multiple sources, such as:

• Claims Data 
  Health plans analyze billing and treatment records to assess performance

• Electronic Health Records (EHRs) 
  Provider-reported data helps measure quality of care

• Patient Surveys 
  Direct feedback enhances insights into care experiences

• Administrative Supplemental Data 
  Data from other sources that may contain information about a member’s health care

Each year, health plans submit HEDIS data to NCQA, which evaluates their performance against national benchmarks and accredits plans accordingly.

Why is HEDIS Important for Health Plans?

• Regulatory Compliance
  Meeting HEDIS standards is essential for Medicare Advantage Star Ratings and Medicaid quality programs, also to maintain NCQA Health Plan Accreditation

• Performance Benchmarking
  Enables health plans to compare quality outcomes against industry standards

• Member Satisfaction and Retention
  Higher HEDIS scores reflect better patient care, leading to increased member trust

• Financial Impact
  Strong HEDIS performance can lead to higher reimbursement rates and incentive payments

• Operational Insights
  Helps health plans identify gaps in care and areas for improvement

How UST HealthProof Helps Health Plans Optimize HEDIS Performance

We support health plans with:

• Data Analytics and Reporting
  Ensuring accurate HEDIS submissions and actionable insights

• Gap Closure Strategies
  Identifying care deficiencies and implementing targeted interventions

• Regulatory Compliance Support
  Aligning HEDIS reporting with NCQA and CMS requirements

By leveraging HEDIS effectively, health plans can enhance care quality, drive operational excellence, and improve member outcomes. Contact UST HealthProof today to optimize your HEDIS strategy.