HEDIS Performance Measures and Reporting Guidelines

This guide provides an overview of the Healthcare Effectiveness Data and Information Set (HEDIS), which is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to evaluate the effectiveness of clinical care among health plans. It outlines the process for collecting and reporting HEDIS data, including the roles of health plans and NCQA in data submission and performance comparison. The document details the various domains of care measured by HEDIS, including effectiveness of care, access to care, and utilization metrics. It also describes the methods for calculating HEDIS measures, such as administrative and hybrid approaches, and emphasizes the importance of HEDIS in assessing quality performance and identifying areas for improvement. Additionally, the guide highlights recent updates to HEDIS measures for 2024, including changes to diabetes measures and the introduction of race/ethnicity stratifications.