HEDIS In Healthcare

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The need for standardized quality measures has been evolving as insurances companies, patients and employers want more data driven health outcomes that improve patient health while reducing cost. The National Committee for Quality Assurance and the federal Agency for Health Care Research and Quality (AHRQ) along with CMS have been a leaders in utilizing evidence based methodologies and measuring quality outcomes to improvement health. The Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely set of quality measures in the U.S incorporating quality measures across many domains of treatment identification strategy in the Initiation and Engagement measures, based on procedure, diagnosis codes and chart audits that is feasible…show more content…
HEDIS is list of health care process measures and intermediate outcome measures based on administrative data, claims and patient records and is utilized by insurance agencies and CMS (Martino, Weinick, Kanouse, Brown, Haviland, Goldstein &… Elliott, 2013). The HEDIS measures include coronary artery disease, diabetes (and its complications), congestive heart failure, stroke, hypertension, obesity, smoking, metabolic syndrome, medication adherence and derive the best quality outcomes from trials and preventive medicine (Eddy, Pawlson, Schaaf, Peskin, Shcheprov, Dziuba & …Eng (2008). In 2005, these HEDIS measures targeted a study of 3.3 million and improvement in performance to those imply prevention of 1.9 million myocardial infractions, 0.8 million strokes, and 0.1 million cases of end-stage renal disease, however if performance would have been 100 percent 1.4 million myocardial infractions could have been prevented because the control of blood pressure has the largest potential effect on quality at a national level (Eddy, Pawlson, Schaaf, Peskin, Schcheprov, Dziuba & …Eng, 2008). These measures follow the best practice guidelines for improving the health of the…show more content…
Then utilizing the results the clinic can drill down to the patients receiving beta-blockers, diabetes (eye & kidney exam) to determine if the correct interventions were being provided by the health care physician and identify gaps in treatment and then ensure the physician receives reminders on preventable measures to close quality care gaps and improve the quality of care provided to patients (Eddy, Pawlson, Schaff, Peskin, Shcheprov, Dziuba & Eng, 2008). I completed a chart audit of over 200 med advantage patient records this week utilizing CPT codes,ICD-9, progress notes, and lab results for HEDIS measures for HgbA1c (9 every 3 months), Diabetic Eye Exams (yearly), Colonoscopy Exam (every 10 years-unless indicated otherwise), Mammograms (yearly after age 50), BP (controlled < 100), and medication adherence (beta blockers, ACE/ARB, cholesterol, diabetic, etc) and my findings would be reported to BCBS, Humana, Clear River, Health Springs and NCQA. The yearly eye diabetic eye exam can detect retinopathy and help ensure early treatment to prevent blindness, control of BP can reduce MI infraction while yearly colonoscopy and mammograms can detect early signs of cancer and HbbA1c can help detect and identify gaps in diabetes
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