United States that is non-profit making in its set up. Its design and objective is that of providing an improved health care quality. This organization was founded in 1990 by Robert wood Johnson foundation.
National committee for quality assurance is that of managing voluntarily accreditation programs or particular individual physicians and extends even to the medical groups. The health plans of various organizations seeking accreditation measure performance level through the use of HEDIS and the CAHPS survey.
Health plan employer data and information set (HEDIS). This program is developed, run, managed and maintained by NCQA. It is majorly used for the purpose of a set performance level measures in a well managed health care industry.
Its original design is that of enabling consumers to make a comparison for a particular health plan performance level to other plans that are provided by other health care givers and with an extension to the national or initial benchmarks.
Albert its initial design was not intended to suit trending, health plan employer data and information set (HEDIS) are on the rise for its use to track and monitor year to year performance level.
Centre for Medicare and Medicaid services (CMS) is usually an incentive provided too. To many health care plans to gather HEDIS data. CMC requirement to the health care organizations is that they submit Medicare HEDIS data so as to give HMO services for those that have enrolled in Medicare under program known as Medicare advantage. HEDIS was first established in 1993 as HEDIS version 2.0.
The 2007 version of HEDIS is the latest with reports on data that ran during 2006 year and contains more than 60 measures. In HEDIS data is obtained through surveys, medical charts and insurance claims for hospitalizations, procedures and visits that are made to the medical offices.
The survey measures have to be carried out by a national committee for quality assurance approved external survey firm by (NCQA). The data collection methodology used by clinical measures are the administrative or hybrid and as indicated by NCQA.
The administrative data entails the electronic records of services provided, as well as insurance claims and registration systems that are in hospitals, clinics, pharmacies, medical offices and the laboratories. For instance, for a given measures categorized as childhood immunizations status would need health plans to find 2 year old.
Children that have been enrolled for Medicare for at least the first one year, the health plans would thus, report the percent of those children that have had specified immunizations. The results obtained for HEDIS must be ascertained and audited by an auditing firm that has been approved by NCQA so that it can present a public reporting.
NCQA has an on line tool that aids it’s reporting. This tool is known as quality compass. This tool gives a detailed data on measures. It is designed for employers, physicians, consultants and insurance brokers that buy health insurance for groups.