HEDIS

The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used set of health care performance measures in the United States. It is developed and maintained by the National Committee for Quality Assurance (NCQA). These measures are designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking, asthma, and diabetes. HEDIS also includes a standardized survey of consumers' experiences that evaluates plan performance in areas such as customer service, access to care, and claims processing.

Many of these measures are scored using claims data; however, additional information that may only be found in a member's chart is often needed. This is where chart abstraction comes into play. PrimeWest Health delegates its chart abstraction to professional chart abstraction companies. During HEDIS season, typically March – June, chart abstractors may contact health care facilities to set up appointments to view charts. Please remember that if you are a PrimeWest Health provider, you are contractually obligated to comply with this request. See the Requirements for Providers chapter of the Provider Manual for more information.

If you are a county case manager, PrimeWest Health may ask for your help in improving our HEDIS scores. County case managers have unique relationships with our members and are well situated to encourage them to receive appropriate health services or screenings.