Analyzing Hedispros and Cons

HEDIS (Healthcare Effectiveness Data and Information Set) HEDIS -- Pros and Cons When it comes to measuring the performance of American health plans, this is where HEDIS (Healthcare Effectiveness Data and Information Set) comes into use. It is widely used throughout America to assess the quality of health services and has 81 measures across 5 care domains. According to NCQA, HEDIS presents a reasonable comparing measure since it is used by so many plans to collect data and also because it is a very accurate measure.

Pros of HEDIS Measures: HEDIS data is used by several health care plans to the employers as well as for self-assessment and improvement. It is also used by employers, consultants and consumers to help in finding the best health plans suitable for their requirements. Results produced by the HEDIS measures are double checked by the auditors who carefully examine the reports to ensure accuracy. The audit is done on the basis of method provided by National Committee for Quality Assurance.

It is also crucial that HEDIS is maintained up-to-date and does not consist of any obsolete data. To look after this issue, the NCQA's Committee on Performance Measurement, which is a group consisting of employers and consultants, organizes meetings and debates to decide which measures should be included in HEDIS and the method of measurement is also decided through mutual consent as well as field tests.

Another advantage of the HEDIS measures is that it consists of a survey called CAHPS 5.0 that plays the function of measuring the amount of satisfaction of the users of HEDIS. It measures whether the members are content with the care service under claims processing, customer care, and the time taken to care for a customer. It also enables a reasonable comparison of health plans on an "apple-to-apple" basis.

The HEDIS results, which are extremely accurate are posted in the web-based Quality Compass and thus provides interactive comparison of results, additionally, it is easy to view. This also helps the members in competitor analysis, quality measurement, and benchmark plan performance. Cons of HEDIS Measures: However, there are also several downsides to using the HEDIS measure to calculate performance of health care. Since the data is not double-checked, it may be unfair to its competitors which are honest and audit their data.

(Berman, 1999) Another problem may arise due to "distraction"; a newly discovered issue, which shows that the method of HEDIS may lower the quality scores due to the self-contradictory aspects of these measures. If more health-care measures (E.g. care of diabetic patients) are added to HEDIS, it might lower the scores due to the mismanagement of results. The less-important or trivial elements of HEDIS maybe be given more time and thus resulting in waste of effort and time.

As a result, the scores will deteriorate alongside the quality, whereas it could have been improved with high scores and proper management. As speculated by Berman (1999), the sole purpose of the HEDIS was to help employers in choosing the best plans quality-wise. However, this was not achieved by HEDIS. The only change it brought to the health-care structure was to disrupt it according to its critics. HEDIS Report Card It enables a person to choose the health-plan deemed most suitable for him and his family.

There are hundreds of health-plans results on this report card. With the help of this report card, a person can get the most time-effective healthcare service as well as proper treatment and preventive measures. To ensure that high quality care is received, a person must choose the correct health-plan and the correct doctor. PROS Quality- Effective as well as cost-effective health-care can be received. Comparison of health plans is also possible. Awareness can be raised among stakeholders regarding the health-care provided by health-plans.

This includes educating about the results of costs and quality factors, briefing the comparison of performances of different health-plans etc. This way quality can be increased while decreasing the costs. (Braine, Carlan, Isaacson, & Raynor, 1994) Braine et al. suggest that different people in different fields can use report cards effectively. For example, corporate purchasers could choose high-value health plans, whereas Public health officials can achieve public health goals with the help of the report card. It enables Providers to select and suggest the suitable health plan.

Improvement in different fields could be brought about by.