HEDIS Resources
What is HEDIS?
The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of national quality performance measures in the healthcare industry. Created by National Committee for Quality Assurance (NCQA), HEDIS is a tool consisting of over 80 quality measurements utilized to compare health plan quality across the nation and is a requirement to be an accredited health plan. NCQA health plan accreditation assures members that they are receiving quality care by health plans and 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 important healthcare topics such as preventative screenings and behavioral health, providers are helping influence positive HEDIS outcomes.
The resources below are general guidelines for improving HEDIS outcomes:
- Best Practices for Coding
- Best Practices for Measures with Telehealth Codes
- Best Practices for Quality of Care
- HEDIS Provider Glossary
HEDIS Measures Monitored by Trillium
Tip Sheets
- AIS-E - Adult Immunization Status
- BCS-E - Breast Cancer Screening
- CCS-E - Cervical Screening in Women
- CHL - Chlamydia Screening in Women
- CIS-E - Childhood Immunization Status
- COL-E - Colorectal Cancer Screening
- IMA-E - Immunizations for Adolescents
- LSC - Lead Screening in Children
- PND-E - Prenatal Depression Screening and Follow-up
- PRS-E - Prenatal Immunization Status
- WCC - Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
- AMR - Asthma Medication Ratio
- BPD - Blood Pressure Control for Patients with Diabetes
- CBP - Controlling High Blood Pressure
- CWP - Appropriate Testing for Pharyngitis
- EED - Eye Exam for Patients with Diabetes
- GSD - Glycemic Status Assessment for Patients with Diabetes
- KED - Kidney Health Evaluation for Patients with Diabetes
- PCE - Pharmacotherapy Management of COPD Exacerbation
- SPC - Statin Therapy for Patients With Cardiovascular Disease
- SPD - Statin Therapy for Patients with Diabetes
- ADD-E - Follow-Up Care for Children Prescribed ADHD Medication
- APM-E - Metabolic Monitoring for Children and Adolescents on Antipsychotics
- FUA - Follow-Up After Emergency Department Visit for Substance Use
- FUH - Follow-Up After Hospitalization for Mental Illness
- FUI - Follow-Up After High-Intensity Care for Substance Use Disorder
- FUM - Follow-up After Emergency Department Visit for Mental Illness
- POD - Pharmacotherapy for Opioid Use Disorder
- SAA - Adherence to Antipsychotic Medications for Individuals with Schizophrenia
- SSD - Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are Using Antipsychotic Medications
- AAB - Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis
- AAP - Adults’ Access to Preventive/Ambulatory Health Services
- APP - Use of First Line Psychosocial Care for Children and Adolescents on Antipsychotics
- IET - Initiation and Engagement of Substance Use Disorder Treatment
- LBP - Use of Imaging Studies for Low Back Pain
- MSC - Medical Assistance With Smoking and Tobacco Use Cessation
- PPC - Prenatal and Postpartum Care
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 Overview for Providers
- NC HealthConnex - Improving Digital Quality
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
The CAHPS Health Plan Survey is a standardized tool used to gather information about members’ experiences with their services and health plans. There are separate surveys for children (age 17 and younger) and adults (age 18 and older). This survey is administered annually. Anyone who receives Tailored Plan, Standard Plan, Medicaid Direct, Eastern Band of Cherokee Indians (EBCI) or Foster Care NC Medicaid services during the six-month measurement period is eligible to participate in the survey in North Carolina. Please refer to the CAHPS Tip Sheet for a list of CAHPS Measures and Tips for Providers.
More information
For further information on HEDIS, please feel free to reach out to the Quality Management Department at PerfMeasures@TrilliumNC.org