HEDIS 3.0 becomes the new outcomes standard
HEDIS 3.0 becomes the new outcomes standard
Plans report more data, use standard surveys
Health Plan Employer Data and Information Set (HEDIS) 3.0 now is the new standard for outcomes reporting, as it becomes effective this month with relatively minor changes from the previous version. Health plans will be monitoring an expanded set of measures, requesting detailed patient information from providers, and using a standardized survey to measure satisfaction.
HEDIS 3.0 promises to shape outcomes measurement around the country and place greater demands on physicians to collect data. The Health Care Financing Administration announced that managed care plans serving Medicare beneficiaries will be required to report on HEDIS measures. The Managed Health Care Association in Washington, DC, also has endorsed HEDIS 3.0 and encourages employers to make use of it.
HEDIS 3.0 will provide more detailed clinical measurements and a standardized health plan member satisfaction survey. "We will have standardization not only with questions but with the way the survey is administered," says Barry Scholl, spokesman for the National Committee for Quality Assurance (NCQA) in Washington, DC, which issues HEDIS.
The Consumer Assessment of Health Plans (CAHPS) survey, developed by the Agency for Health Care Policy and Research in Rockville, MD, will become a part of the HEDIS "testing set," which means it will be evaluated as a possible future measure, says Carol Cronin, senior vice president of Health Pages, a New York City-based consumer magazine and a member of the NCQA’s Committee on Performance Measurement.
The changes from the draft version to the final HEDIS 3.0 include:
• Annual, not biannual, screening will remain the standard for diabetic eye exams.
• The Committee on Performance Measure ment will continue to consider how to identify high-risk adults who should receive flu shots.
• Member surveys will include questions about medical advice to stop smoking.
• Appointment and telephone access will be measured through the member survey, rather than through methods to determine actual waiting times.
While measurements currently are reported on a health-plan level rather than on a provider level, that could change in the future, Cronin predicts. "To make this relevant to consumers, we have to figure out what’s inside the plan [in terms of provider outcomes]," she says.
Even now, physicians should be aware of the HEDIS indicators, she says. "Physicians and NCQA have the same goal in mind, which is improving the quality of care that health plans deliver," Scholl says.
[Editor’s note: A copy of the four-volume set of HEDIS 3.0 may be obtained from NCQA for $375. Telephone: (800) 839-6487.]
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