HEDIS Services
Enhancing Quality, Accuracy, and Compliance in Healthcare Reporting
The Healthcare Effectiveness Data and Information Set (HEDIS) is a standardized performance measurement tool used to evaluate the quality and effectiveness of services provided by managed care plans. Developed by the National Committee for Quality Assurance (NCQA), HEDIS ensures consistent and objective assessment of healthcare delivery, enabling data-driven insights that support continuous quality improvement.
By measuring outcomes across multiple domains, HEDIS plays a vital role in enhancing care delivery, improving patient outcomes, and supporting value-based care initiatives.
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Why HEDIS Matters
HEDIS is more than a reporting requirement—it’s a tool that drives quality, accountability, and informed decision-making across healthcare organizations. Key benefits include:
- Informs Decision-Making: Provides standardized data allowing consumers and purchasers to compare health plan performance.
- Drives Quality Improvement: Supports the evaluation and enhancement of clinical care and service delivery.
- Supports Preventive Care: Tracks delivery of essential preventive health services.
- Monitors Key Areas: Evaluates chronic disease management, access to care, service utilization, and patient demographics.
- Regulatory Compliance: Reporting HEDIS data is mandated by CMS (Centers for Medicare & Medicaid Services) and DHCS (Department of Health Care Services).
How HEDIS Measures Are Collected
HEDIS data is collected using two primary methods, each providing reliable and actionable insights:
1. Administrative Method
- Relies on claims, encounter data, pharmacy records, and lab results.
- Rates are calculated for the entire eligible population for specific measures.
- Provides a broad, data-driven overview of care delivery.
2. Hybrid Method
- Combines administrative data with medical record reviews for greater accuracy.
- Uses a statistically valid sample (typically around 411 members) from the eligible population.
- Applied to select measures where clinical documentation supplements claims data.
Key HEDIS Domains
HEDIS evaluates performance across multiple domains to ensure comprehensive quality assessment:
- Effectiveness of Care: Evaluates how well care meets established clinical guidelines.
- Access/Availability of Care: Assesses how easily members can obtain needed services.
- Utilization & Risk-Adjusted Utilization: Measures healthcare service use while accounting for patient risk factors.
- Experience of Care (CAHPS): Captures member satisfaction and experience through standardized surveys.
- Electronic Clinical Data Systems (ECDS): Uses EHRs and clinical databases for timely, accurate reporting.
- Health Plan Descriptive Information: Provides context about plan characteristics, enrollment, and operations.
CAHPS Surveys: Capturing Patient Experience
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey gathers insights into member experiences with health plans and providers. CAHPS results are increasingly important in HEDIS ratings and overall quality assessments, helping organizations understand patient perspectives and improve care delivery.
Electronic Clinical Data Systems (ECDS)
ECDS leverages electronic sources such as Electronic Health Records (EHRs), health information exchanges, and quality management databases. This method supports more timely and comprehensive reporting of certain HEDIS measures, enhancing accuracy, consistency, and data integration.
Our HEDIS Services
At Proactive Healthcare Services, we help healthcare organizations navigate HEDIS reporting with clarity, accuracy, and confidence. Our services include:
- Measure selection aligned with your patient population and clinical focus
- Data abstraction, validation, and gap analysis
- Reporting accuracy checks and submission guidance
- Quality improvement strategy recommendations
- Ongoing performance monitoring and compliance support
We ensure that every step of HEDIS reporting is compliant, audit-ready, and actionable, empowering organizations to improve quality outcomes while meeting regulatory requirements.
Who Can Benefit from HEDIS Support?
Our HEDIS services are designed for healthcare professionals and organizations seeking accurate reporting, regulatory compliance, and quality improvement guidance, including:
- Physicians and Specialists
- Clinics and Outpatient Practices
- Multi-provider Health Organizations
- Managed Care Plans
Whether you are reporting for a small practice or a large health system, our team provides practical, human-centered support that builds trust, reduces risk, and enhances performance.
Partner with Proactive Healthcare Services
HEDIS reporting is complex, but with the right expertise, it becomes a powerful tool for improving patient care, operational efficiency, and regulatory compliance.
Contact us today to learn how Proactive Healthcare Services can support your organization with accurate, reliable, and actionable HEDIS reporting.
