AFMC has received its 2020 Healthcare Effectiveness Data and Information Set (HEDIS®) certification for health plan reporting. HEDIS is a comprehensive set of standardized performance measures widely used to measure and improve health care quality. HEDIS measures are relied on by government regulators, health plan payers, provider organizations, employers and consumers to provide information, identify quality and help compare health plan performance and make reliable comparisons between managed care plans.

Used by more than 90% of health plans to measure their performance, HEDIS standards include benchmarks for health quality indicators such as asthma medication use, use of beta-blocker treatment after a heart attack, controlling high blood pressure, diabetes care, breast cancer screening, antidepressant medication management, immunization status, mental health care and advising smokers to quit. HEDIS’ 90 performance standards range across six domains of care: effectiveness, access and experience of care, utilization, health plan information, and measures collected from electronic clinical data systems. Data are audited to verify validity and reliability.

AFMC’s Analytics department uses HEDIS standards to track health indicators and aid in selecting potential quality improvement activities. Certification-seeking HEDIS vendors are required to compute HEDIS measures using the current specifications and then upload test data to ensure their software computes the HEDIS measures accurately. Any vendor or consultant that plans to use HEDIS measure specifications for commercial purposes (e.g., offer products or services for closing gaps in care, population health activities, and calculate measure rates for submission to external programs), or to reproduce, distribute or publish HEDIS measure specifications must use an NCQA-Certified vendor or contract directly with NCQA to certify their measure logic.

Studies show that health plans that meet HEDIS standards are associated with lower health care costs. Because the measures reflect actual patient care, they can be used for quality improvement efforts. Analysis of HEDIS data is also used to identify gaps in care and use of preventive care in people with chronic diseases such as diabetes, heart or lung disease and other costly conditions.

“AFMC prides itself on the quality of health-related services we provide to health care consumers and providers,” said Ray Hanley, president and CEO of AFMC. “Our HEDIS certification ensures that our standards remain high.”

Accuracy is critical for health plans, provider organizations and other entities that rely on quality measurement data to make decisions for quality reporting and inform value-based contracting. By earning NCQA Measure Certification, organizations know their measure logic has passed the industry’s most rigorous assessment.

Organizations must recertify each year to continue using this important evaluation tool, which is developed and maintained by the NCQA.