Healthcare Effectiveness Data and Information Set

Get an overview of Healthcare Effectiveness Data Information Set (HEDIS^®) and learn what Health Net Federal Services, LLC (HNFS) is doing related to performance measurement.

HEDIS is a group of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS is used by health plans to measure performance on important dimensions of care and service, such as effectiveness of care and access to care, and makes it possible to compare the performance of health plans based on like performance measures.

• Preventive Cancer Screenings
  In the U.S., cancer is the second most common cause of death, surpassed only by heart disease. In 2010, cancer accounted for nearly one of every four deaths. Prevention, screening and early detection are the best weapons to combat serious illnesses; often the best treatment of cancer is early detection when it may be most treatable. Health Net Federal Services is implementing initiatives to help improve the following three cancer screening rates among the target groups listed below:
  
  • Breast Cancer Screening
    Women over 50 who have had at least one mammogram every two years.
    
  • Cervical Cancer Screening
    Women 21–64 who have had a Pap smear every three years; or women 30–64 who have had a Pap smear and HPV co-testing every five years.
    
  • Colorectal Cancer Screening
    Adults over 50 who had one or more appropriate screenings for colorectal cancer. Screening intervals vary according to the method of screening. Appropriate screening includes any of the following five procedures:
    
    • fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year 
    • flexible sigmoidoscopy every five years 
    • colonoscopy every 10 years
    • fecal DNA testing every one or three years
    • computed tomography colonoscopy every five years

• Diabetes Care Screenings
  Studies show diabetes benefits from secondary prevention, such as controlling glucose, lipid and blood pressure levels, and tertiary prevention including screening for eye, foot and kidney abnormalities, followed by appropriate treatment. Health Net Federal Services is implementing initiatives to help improve the following diabetes screening rate:
  
  • Hemoglobin A1c Testing
    Adults with a diagnosis of Type 1 or Type 2 diabetes who had an appropriate HBA1c blood test every year.
    

• Behavioral Health Aftercare
  Timely follow-up care may help lower the rate of re-hospitalization and help beneficiaries transition into the community. Evidence shows as the number of days between hospital discharge and follow-up appointment increase, the likelihood of treatment non-adherence does as well, which increases the risk of re-hospitalization. Health Net Federal Services is implementing initiatives to help improve follow-up care after discharge among the target group listed below:
  
  • Seven and 30-Day Follow-Up After Hospitalization for Behavioral Health Illness
    Beneficiaries age six and above who were hospitalized for acute treatment of selected behavioral health disorders and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a behavioral health practitioner within seven days or within 30 days after discharge.

• Well Child Visits
  Just as preventive care is important for adults, well child visits (WCVs) are vital to keep children healthy; WCVs are the primary opportunity for prevention or early intervention for physical, developmental and behavioral problems in a child. Health Net Federal Services is implementing initiatives to help improve the WCV rate among the group listed below:
  • Well Child Visits in the First 15 Months of Life
    Children who turned 15 months old during the measurement year and had at least six well-child visits with a primary care manager during their first 15 months of life. 
     
• Hospital Readmissions Within 30 days of Discharge    
  • Adult acute inpatient stays that were followed by an unplanned acute readmission for any diagnosis within 30 days      after discharge.
     
• Medication Management for People with Asthma
  • Adults and adolescents 5–64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate asthma controller medications that they remained on for at least 75 percent of the treatment period.
     
• Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications
  • Adults 18–64 years of age with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test (ie, glucose test or HbA1c test) during the measurement year.