HEDIS Data Entry Tools

In its work with the health care sector, Lattice Group has designed, developed and implemented custom HEDIS Data Entry and QA Tools used by clinical auditing teams to capture member/patient diagnosis codes and diagnosis information, and perform Quality Analysis of charts that have been Data Entered.  This information is used to calculate if each member is compliant based on NCQA (National Committee for Quality Assurance) specifications and allow plan Administrators to identify performance, view the difference between the QA’s data and the Abstractor’s data, along with the ability to grade the Abstractor.

About HEDIS

HEDIS (short for “Healthcare Effectiveness Data and Information Set”) is a widely used set of performance metrics developed and maintained by the National Committee for Quality Assurance, or NCQA (NCQA.org). In 2015, it consisted of a set of 83 measures divided into 5 domains of care:

  • Effectiveness of Care
  • Access/Availability of Care
  • Experience of Care
  • Utilization and Relative Resource Use
  • Health Plan Descriptive Information
2016 measures are slightly different, divided into 5 domains of care:
  • Effectiveness of Care
  • Access/Availability of Care
  • Experience of Care
  • Utilization and Risk Adjusted Utilization
  • Relative Resource Use

The Goal of HEDIS

Overall, the goal of HEDIS is to provide consumers with a way of comparing different health plans side by side and against national or regional benchmarks to in turn allow better decision-making when choosing a healthcare plan.  While the system is not without controversy, it is a tool used by more than 90% of American health plans to measure performance on care and service. In addition, the Centers for Medicare and Medicaid (CMS) requires that HMOs submit Medicare HEDIS data under a program called Medicare Advantage (created in 1997 and revised in 2003 as the “Part C” plan), which further provides a motivation for its use.

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