HEDIS® Management

Since its inception in 1993, the Healthcare Effectiveness Data and Information Set (HEDIS®) has become the healthcare industry standard in managed care performance measurement. Health plans are required to report HEDIS performance results to the National Committee for Quality Assurance (NCQA). These clinical quality performance measures provide purchasers and consumers with a standardized performance comparison mechanism when evaluating health plans.

Each year we participate in the HEDIS Measure CertificationSM program to provide health plans with tools to meet HEDIS reporting requirements. By combining HEDIS methodology with The Johns Hopkins ACG® System, our solution gives you the power to integrate member risk and resource utilization, and facilitate member/provider communication.

  • Identify member-level care gaps to target the right individuals for proactive care management
  • Integrate predicted risk and resource utilization
  • Continuously measure, monitor, and manage HEDIS rates
  • Participate in Allowable Adjustment measure certification to support year round monitoring
  • Verify compliance with HEDIS specifications through precise automated testing
  • Satisfy the manual source code portion of the HEDIS Compliance Audit™
  • See summary HEDIS measure results in a format consistent with NCQA submission requirements

Additionally, we have valuable tools to enable your HEDIS planning. Our timeline is updated annually to keep you on track with deliverables throughout the year, while our vendor checklist will help you determine if a change could improve your ability to meet your goals. You can easily download any of our content below.

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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).