iHEDIS

Commitment

As a service to our clients, iHEDIS is verified by NCQA certified auditors to ensure reporting is precise and adheres to the HEDIS® guidelines. NCQA auditors visit onsite, analyze and grade our system. We consistently receive excellent ratings from the NCQA.

HEDIS at Work

HEDIS is a reporting system that evaluates the effectiveness of health plans. HEDIS reports are generated based on standardized performance measures from NCQA.
HEDIS tracks information on defined areas of public health, such as breast cancer screening, heart disease, smoking and childhood immunizations, then generates rigorous and comprehensive evaluation reports. The reports are published in an NCQA approved health plan directory. Employer groups can search the directory to compare and evaluate health plans.

There are two parts to HEDIS reporting. Administrative – claim, membership, provider and other ancillary information is downloaded from the computer to the HEDIS system. Chart review – manual analysis of treatment performed outside of the provider network. This information is generally left out of the HEDIS report. HEDIS provides extra data files to support medical chart review.

Standard Reports

Client data such as medical claim, membership and provider information are collected from the health plan and run against the ikaHEDIS reporting system to generate reports on these topics:

• Effectiveness of Care
• Access/Availability Care
• Health Plan Stability
• Use of Services
• Cost of Care

Health Plan Description

Consumer experience information, such as customer service and claims processing is also included in the report.

The Key to Informed Choice

The Health Plan Employer Data and Information Set (HEDIS®) evaluation has become a requirement for health plans that must be approved by the National Committee of Quality Assurance (NCQA) to maintain viable candidacy for employer groups. Employer groups rely on HEDIS reports during health plan evaluation and are vitally concerned with the quality of care that physicians provide within their plan.

In addition to the standard HEDIS reports that measure the quality of health plans, iHEDIS incorporates rigorous HEDIS standards to provide expert evaluation of PCPs and health plans.

iHEDIS may be one of the only quality measures for PCPs available to plans, and thus, the key to informed choices when selecting PCPs as network providers. In the past, plans were unable to assess the quality of care each PCP provided. With iHEDIS, the technology is in place to provide plans with a “report card” on quality performance of PCPs.

Spotlight on Quality

PCP evaluation through iHEDIS enables plans to evaluate physicians and provide incentives to ensure physicians perform at their highest level. The plan assigns a grade to the PCP based on performance according to HEDIS standards. The incentive grade elevates the PCP rating within the health plan’s HEDIS report and encourages continued excellence. Incentive grading favors the plan because employer groups
view HEDIS reports on plan and PCP performance.

iHEDIS PCP evaluation reflects the PCP’s quality performance on all levels and provides a report card for quality of care. For example, compare two PCPs who each have 300 females at risk of breast cancer between the ages of 52 – 59 years. Physician A has a mammography success rate of 50%; physician B has a success rate of 88%.

The relative rates within the plan are as follows:
Physician A: .76/.50 = 1.55
Physician B: .76/.88 = .86
Physician A’s performance level for mammography is 55% worse than the average, whereas physician B is 14% more effective. This data, together with other HEDIS measures, are averaged against peer ratings to provide a measure of success. This composite average is called the ZQI, or the Zak Quality Index.

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