Major Health Plan Quality Measurement Sets
You can use two well-established health plan measurement sets as the basis for collecting data and preparing comparative information for your audience:
- Healthcare Effectiveness Data and Information Set (HEDIS)
- CAHPS Health Plan Survey (CAHPS stands for Consumer Assessment of Healthcare Providers and Systems)
These measures have been endorsed by the National Quality Forum, a multistakeholder organization established to standardize health care quality measurement and reporting. Learn about the National Quality Forum.
HEDIS®
HEDIS refers to a widely used set of performance measures in the managed care industry. More than 90 percent of health plans—HMOs, POS plans, and PPOs—use HEDIS to measure performance. HEDIS is managed by the National Committee for Quality Assurance (NCQA), a private, non-profit organization that accredits and certifies health care organizations. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. Learn about the NCQA.
HEDIS enables consumers and purchasers to compare health plan performance to other plans and to national or regional benchmarks. Consisting of over 70 measures of process, structure, and outcomes, HEDIS addresses a spectrum of care from prevention to acute to chronic care. It also encompasses health plan members’ assessments of their experiences with care as measured by the CAHPS Health Plan Survey (described below). NCQA adds, deletes, and revises HEDIS measures annually.
HEDIS scores are regarded as highly credible, in part because an NCQA-approved auditing firm must validate results. Also, an NCQA-approved external survey organization must administer the CAHPS survey when it is part of a health plan’s HEDIS submission to NCQA.
Data source: You can obtain HEDIS results directly from health plans or by purchasing access to NCQA’s Quality Compass® database of health plan performance results. More details about Quality Compass are provided in Databases Used for Health Plan Quality Measures. For more information about HEDIS or to purchase HEDIS publications, visit NCQA’s Web site at https://www.ncqa.org.
CAHPS® Health Plan Survey
CAHPS refers to a family of standardized surveys that can be used to gather and report information on consumers’ experiences with health plans and providers. The surveys are developed and supported by a consortium of researchers with funding from the Agency for Healthcare Research and Quality (AHRQ).
The CAHPS Health Plan Survey consists of over 40 items that ask the respondent to rate their experiences with different aspects of care, including access, timeliness, communication, courtesy, and administrative ease. Instruments are available for adults and children in commercial, Medicaid, and Medicare populations.
Data source: Some sponsors generate CAHPS data by surveying their own audiences (e.g., employees, beneficiaries); however, sponsors typically get this information directly from the health plans or from NCQA because results from this CAHPS survey are incorporated into HEDIS. For more information about the survey, visit the CAHPS website.
Also in "Measures of Health Plan Quality"
- Examples of Health Plan Quality Measures for Consumers
- Major Health Plan Measurement Sets
- Databases Used for Health Plan Quality Measures
