Understanding HEDIS

Understanding HEDIS

What is HEDIS?

HEDIS® is the common acronym for Healthcare Effectiveness Data and Information Set, and is one of the most widely used tools available to report on the effectiveness of healthcare practices and procedures. As stated by CMS.gov;

HEDIS is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance.

HEDIS® was created by the National Committee for Quality Assurance (NCQA) to develop to help evaluate the quality of care provided by Special Needs Plans. Originally designed to help compare health plans, HEDIS data is annually used to track year-to-year performance.

HEDIS Measures

Measuring the effectiveness of healthcare practices manifests itself in the form of HEDIS Measures. A few common measures might include:

  • Controlling High Blood Pressure
  • Colorectal Cancer Screening
  • Cervical Cancer Screening
  • Statin Therapy for Patients With Cardiovascular Disease and Diabetes
  • Use of High-Risk Medications in the Elderly
  • Fall Risk Management

Overall, there are roughly 90 established measures sanctioned by NCQA. HEDIS measures vary year to year and changes as the need to monitor effectiveness changes.

What Is The Purpose of HEDIS

HEDIS performance data helps doctors, hospitals, and insurance providers achieve a high level of care using the most efficient practices and procedures. Using this valuable data service providers can identify opportunities for improvement in their process stack. By laying out specific quality measures, providers can monitor the success of any quality improvement programs they initiate. Successes in these initiatives can be tracked, allowing a pivot to better practices if the expected measure of success is not realized.

The ultimate value of HEDIS measures is to hold each management tier accountable for effective patient care while carefully monitoring costs.


KDJ Consultants’ stellar track record in managing HEDIS initiatives means you can improve your patient care and improve your best practices. Contact KDJ Consultants today for a consultation.


Meet The Author

Melissa Buchanan is the Director of Compliance Management & HEDIS Clinical Manager for KDJ Consultants. A veteran RN, Melissa spent years in Neonatal care and other practical disciplines before moving into Administration and Nursing Informatics, for which she holds a Master's Degree.