Posted: June 14th, 2023

Discuss in depth the development and execution of HEDIS measures

ASSIGNMENT INSTRUCTIONS:
Discuss in depth the development and execution of HEDIS measures, and describe how they have improved the overall population health in the United State or how they may have fallen short. Identify which performance measures you think have had the greatest impact on health outcomes, discuss what you feel are the three most significant 2021 HEDIS changes, and explain why.

Introduction:

Healthcare Effectiveness Data and Information Set (HEDIS) measures are a standardized set of performance measures that evaluate healthcare delivery by healthcare organizations. The National Committee for Quality Assurance (NCQA) is responsible for developing and executing these measures. HEDIS measures are used to evaluate healthcare plans and providers on quality, access, and utilization of healthcare services. This essay will discuss the development and execution of HEDIS measures, how they have improved the overall population health in the United States, or how they may have fallen short. Additionally, I will identify the performance measures with the greatest impact on health outcomes, the three most significant 2021 HEDIS changes, and explain why.

Development and Execution of HEDIS Measures:

The development of HEDIS measures began in 1991 by NCQA. These measures are used to evaluate the quality of care provided by health plans and providers. HEDIS measures are updated annually and have become a crucial tool for measuring the quality of healthcare in the United States. The measures focus on several areas of healthcare, such as preventive care, chronic disease management, and behavioral health.

HEDIS measures are developed using evidence-based guidelines, and the NCQA works with medical experts, clinicians, and health plans to ensure that the measures are relevant and reliable. The measures are then tested and piloted to ensure their accuracy and validity. Once finalized, the measures are shared with healthcare organizations to enable them to assess their performance and improve healthcare delivery.

Impact on Population Health:

HEDIS measures have had a significant impact on improving population health in the United States. For example, measures focused on preventive care, such as breast cancer screening, have increased the number of women who receive regular mammograms, leading to early detection and treatment of breast cancer. Similarly, measures focused on chronic disease management, such as diabetes care, have improved patient outcomes and reduced the number of hospitalizations related to diabetes.

HEDIS measures have also helped to identify disparities in healthcare delivery based on race, ethnicity, and socioeconomic status. By measuring healthcare performance and outcomes, healthcare organizations can identify areas for improvement and implement targeted interventions to address disparities and improve health outcomes.

Shortcomings:

Although HEDIS measures have had a positive impact on population health, they may fall short in some areas. One of the limitations of HEDIS measures is that they may not capture the complexity of healthcare delivery fully. The measures may not account for individual patient preferences or variations in care delivery based on the patient’s clinical condition or comorbidities. Additionally, the measures may not capture the impact of social determinants of health, such as access to healthy food, safe housing, and transportation.

Greatest Impact on Health Outcomes:

The performance measures with the greatest impact on health outcomes are those that focus on preventive care, chronic disease management, and behavioral health. Examples of these measures include breast cancer screening, cervical cancer screening, childhood immunizations, diabetes care, and depression screening. By focusing on these areas, healthcare organizations can identify patients who are at risk for disease and provide timely interventions to prevent or manage their conditions.

Three Significant 2021 HEDIS Changes:

The three most significant 2021 HEDIS changes are:

Telehealth: Due to the COVID-19 pandemic, telehealth has become an essential component of healthcare delivery. HEDIS measures have been updated to include telehealth visits for several measures, such as well-child visits, prenatal care, and behavioral health follow-up visits.

Social Determinants of Health: HEDIS measures have been updated to include new measures that focus on social determinants of health, such as food insecurity, housing instability, and transportation. These measures will help healthcare organizations identify patients who may be at risk due to social determinants of health and provide targeted interventions to improve health outcomes.

Mental Health: HEDIS measures have been updated to include new measures that focus on mental health, such as depression screening, follow-up after hospitalization for mental illness, and medication management for people with mental illness. These measures will help healthcare organizations identify and manage mental health conditions effectively, which is essential for improving overall population health.

These three changes are significant because they address critical areas of healthcare that have become increasingly important due to the COVID-19 pandemic. Telehealth has become a crucial component of healthcare delivery, and the inclusion of telehealth visits in HEDIS measures will ensure that healthcare organizations are providing high-quality care through telehealth. The inclusion of social determinants of health measures in HEDIS will help to identify and address the root causes of health disparities and improve health outcomes. Finally, the focus on mental health measures is critical because mental health conditions have become increasingly prevalent during the pandemic, and effective management of these conditions is essential for improving overall population health.

Conclusion:

In conclusion, HEDIS measures are a standardized set of performance measures that evaluate healthcare delivery by healthcare organizations. They have had a significant impact on improving population health in the United States, particularly in areas such as preventive care, chronic disease management, and behavioral health. While there may be limitations to the measures, HEDIS has proven to be an essential tool for healthcare organizations to measure and improve healthcare delivery. The 2021 HEDIS changes, including the inclusion of telehealth, social determinants of health measures, and mental health measures, are significant steps towards improving overall population health.

Works Cited
National Committee for Quality Assurance. (2021). HEDIS measures and technical resources. https://www.ncqa.org/hedis/measures/

American Medical Association. (2021). COVID-19 telehealth coverage policies. https://www.ama-assn.org/practice-management/digital/covid-19-telehealth-coverage-policies

Centers for Disease Control and Prevention. (2021). Mental health. https://www.cdc.gov/mentalhealth/index.htm