HEDIS Resources

What is HEDIS?

The acronym HEDIS stands for Healthcare Effectiveness Data and Information Set and, according to the National Committee for Quality Assurance (NCQA), is the most widely used set of performance measures in the managed care industry. HEDIS is a tool consisting of over 90 measurements utilized to compare health plan quality across the nation and is a requirement to be an accredited health plan. The accreditation seal assures members/patients that they are being cared for by both a quality health plan and quality providers.

For more information about HEDIS, please visit NCQA website - or reach out to our Quality Management department at PerfMeasures@TrilliumNC.org.

Provider Resources for Improving Quality

Providers are vital to helping maintain accreditation status and ensuring quality care is delivered. By educating patients on the importance of preventative screenings, managing chronic conditions, addressing behavioral health matters, etc. providers are directly impacting the HEDIS rates.

Below are several resources for HEDIS metrics. Correct implementation of the best practices and the Numerator Codes Dashboard decreases and/or removes the need for medical record review and improves timeliness of closing gaps in care.

The Numerator Codes Dashboard lists all codes required for claims to be included in the numerator for HEDIS measures. Using codes properly will help provide more accurate HEDIS rates and improve quality of care.

• Best Practices for Coding
• Best Practices for Measures with Telehealth Codes
• Best Practices for Quality of Care
• Numerator Codes Dashboard (Excel)

HEDIS Measures Monitored by Trillium

HEDIS My Learning Campus (MLC) Trainings

The Quality Management Department in Trillium has developed the following HEDIS-related trainings to offer a more detailed look at HEDIS reporting, the importance of HEDIS, what it means, what it means to the agency and providers, and talk more about measurement-based care in general. You can locate the following trainings on the My Learning Campus website.

• HEDIS 2023 Overview
• NCHIE HealthConnex Training

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

The CAHPS Health Plan Survey is a member survey that assesses satisfaction with services provided by the health plan as well as member perception of the accessibility and communication of providers. This survey is conducted annually, and applicable measures are then compared with NCQA national benchmarks.

How can providers help?

1. Open the lines of communication with your patients. Communicate thoroughly and in a way they can understand.
2. Listen to your patients and make sure they understand what you have discussed/ordered, etc.
3. Submit referrals and obtain authorizations as appropriate.
4. Be aware of patient wait times and limit them when possible.
5. Encourage preventive measures such as influenza and pneumococcal vaccines.