Administrative Healthcare Data

Chapter 11: HEDIS

Introduction

The Business Case

The Technical Challenges

Reporting System Components

Colorectal Cancer Screening

Definition

Eligible Population

Exclusions to Eligibility

Compliant Population

Hybrid Specification

Case Study: Developing a Rate for Colorectal Cancer Screening

Create a Driver Table

Clean Up of Membership Data

Check Continuous Enrollment

Identify the Denominator

Determine Compliant Population

Compute Rate

Conclusion

Introduction

In today’s ever-changing healthcare landscape, organizations are being required to demonstrate quality across the health care delivery continuum.  One early result of this mandate is that 90 percent of America’s health plans use HEDIS (Healthcare Effectiveness Data and Information Set) as ...