HEDIS® Management

Improve clinical quality performance and increase efficiency to manage workflow processes

The Healthcare Effectiveness Data and Information Set (HEDIS) is the industry standard in managed care performance measurement. 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 NCQA’s Measure CertificationTM program to provide health plans with tools to meet HEDIS reporting requirements. This certification provides direct benefit to our clients with reduced source code review that would otherwise be required for the HEDIS Compliance Audit and AMP audit review. Both of those programs have implications on customer accreditation, quality bonus incentives and published quality ratings.

By combining HEDIS methodology with The Johns Hopkins ACG® System, our proprietary solution, CareAnalyzer®, has the power to integrate member risk and resource utilization, thus facilitating member/provider communication and improving clinical quality performance.

Clinical Repository is a companion tool that offers additional benefits:

  • captures supplemental and hybrid data
  • features measure-specific abstraction forms that validate against measure requirement
  • provides workflow for over-read storage for chart images with annotations

For organizations participating in the Integrated Healthcare Association’s Align.Measure.Perform. (AMP) program, CareAnalyzer also provides certified AMP measurement and submission files.

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