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HEDIS®

HEDIS® (Healthcare Effectiveness Data Information Set) is a set of nationally standardized measures commonly used in the managed care industry to measure a health plan's performance during the previous calendar year. The measures were developed by the National Committee for Quality Assurance (NCQA) and are updated annually. 

The State of Missouri requires Missouri Care to report specific measures yearly to the Department of Health and Senior Services (DHSS) and to the MO HealthNet Division. Measures are also subject to a national audit and reported to NCQA.

Measures Missouri Care reports annual HEDIS rates for the following measures:

  • Effectiveness of care – assesses the delivery of preventive care services and services related to chronic disease
  • Childhood immunizations
  • Immunizations for adolescents
  • Lead screening in children
  • Breast cancer screening
  • Cervical cancer screening
  • Chlamydia screening in women
  • Appropriate testing for children with pharyngitis
  • Appropriate treatment for children with upper respiratory infection
  • Avoidance of antibiotic treatment in adults with acute bronchitis
  • Use of appropriate medications for people with asthma
  • Medication management for people with asthma
  • Controlling high blood pressure
  • Diabetes
  • Use of imaging studies for low back pain
  • Antidepressant medication management
  • Follow-up care for children prescribed ADHD medication
  • Follow-up after hospitalization for mental illness
  • Access/availability of care – assesses the availability of health care to plan members
  • Prenatal and postpartum care
  • Annual dental visit
  • Satisfaction with the experience of care – measures member satisfaction through a survey sent to members
  • Utilization and relative resource use – addresses utilization measures, such as discharge rates and average length of stay
  • Well-child visits in the first 15 months of life
  • Well-child visits in the third, fourth, fifth, and sixth year of life
  • Adolescent well-care visits
  • Ambulatory care – ER visits
  • Behavioral health utilization – percentage of members receiving inpatient & intermediate care & ambulatory services
  • Identification of alcohol and other drug services 

HEDIS Medical Record Review
In spring, the health plan will increase HEDIS rates by supplementing claims data with data obtained from member medical records. Missouri Care’s Quality Management staff contacts provider offices to conduct medical records review as part of the HEDIS process.

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Last Updated On: 12/14/2015
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