What Is HEDIS®?

By: AvMed News AvMed News

Each year, AvMed uses a set of quality metrics to measure performance on important aspects of care. This set of metrics is known as HEDIS, or Healthcare Effectiveness Data and Information Set. Using HEDIS, AvMed reviews effectiveness and access of care along with Member satisfaction.

Why is this important to you?

  • HEDIS can help identify noncompliant Members to ensure they receive necessary screenings and treatment.
  • HEDIS allows you to monitor and manage a patient’s care.

HEDIS measures include everything from preventive care like breast cancer and colon cancer screenings to immunizations as well as chronic care measures like diabetes and osteoporosis care. It’s also helpful for behavioral health issues, including opioid abuse.

With your help, we can improve health care. To better understand HEDIS, here’s a closer look at several measures for different behavioral health issues, per NCQA.org:

Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)

Assesses adults and adolescents 13 years of age and older with a new episode of alcohol or other drug (AOD) dependence (e.g., prescription opioids) who received the following:

  • Initiation of AOD Treatment: Adolescents and adults who initiated treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth or medication-assisted treatment (MAT) within 14 days of diagnosis.
  • Engagement of AOD Treatment: Adolescents and adults who initiated treatment and had two or more additional AOD services or MAT within 34 days of the initiation visit.

Follow-Up After Hospitalization for Mental Illness

Assesses adults and children 6 years of age and older who were hospitalized for treatment of selected mental health disorders and had an outpatient visit, an intensive outpatient encounter or a partial hospitalization with a mental health practitioner. The measure identifies the percentage of Members who received follow-up within seven days of discharge and within 30 days of discharge.

Antidepressant Medication Management (AMM)

Assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on their antidepressant medications.

Two rates are reported:

Effective Acute Phase Treatment: Adults who remained on an antidepressant medication for at least 84 days (12 weeks).

Effective Continuation Phase Treatment: Adults who remained on an antidepressant medication for at least 180 days (six months).

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)

Assesses the use of first-line psychosocial care for children and adolescents ages 1 to 17 on antipsychotics who had a new prescription for an antipsychotic medication as a first-line treatment (without first having a psychosocial care visit).

Have questions about HEDIS? Call AvMed’s Provider Services Center at 1-800-452-8633.