Full definition
HEDIS (Healthcare Effectiveness Data and Information Set) is the dominant US health-plan quality measurement framework, published by the National Committee for Quality Assurance (NCQA). 90+ performance measures spanning preventive care, chronic-disease management, behavioural health, access to care, member experience, and resource utilisation.
Used by 90%+ of US health plans for quality reporting. Affects star ratings (Medicare Advantage), accreditation, and increasingly contractual payment incentives. CMS uses HEDIS-derived measures in Medicare Advantage Star Ratings and Marketplace Quality Ratings.
For clinic technology: HEDIS measure capture happens at the clinical encounter — the EHR + clinic software must capture the relevant quality data points. MOVO-X supports HEDIS measure tracking via structured clinical data capture and FHIR-based reporting.
Where hedis (healthcare effectiveness data and information set) is used
- US health plan quality reporting
- Medicare Advantage star ratings
- Health plan accreditation (NCQA)
- Population-health programme effectiveness
Types of hedis (healthcare effectiveness data and information set)
Effectiveness of Care
Preventive screenings, chronic-disease management, behavioural health.
Access / Availability
Network adequacy, appointment access, language support.
Experience of Care
CAHPS — member-reported experience.
Utilisation
Resource use — admissions, ED visits, pharmacy.
Health Plan Descriptive
Information about plan structure and operations.
Quantified benefits
- ▸Standardised quality measurement across US health plans
- ▸Drives improvement programme investment
- ▸Consumer comparison transparency
- ▸Foundation for Medicare Advantage star ratings
Frequently asked
Does HEDIS apply to clinics directly?+
HEDIS is a health-plan measurement framework. Clinics in plan networks contribute through clinical data capture; the plan calculates and reports HEDIS scores. Plan-clinic collaboration on HEDIS improvement is common.
How does MOVO-X support HEDIS?+
Structured clinical data capture for HEDIS-relevant measures (immunisations, screenings, A1c results, etc.). FHIR-based reporting to plan partners. Quality measure dashboards.
HEDIS vs MIPS?+
HEDIS is health-plan quality. MIPS is clinician-payment quality. Some measures overlap; the underlying clinical data capture is the same.
What about Medicare Advantage star ratings?+
CMS uses HEDIS-derived measures in star ratings calculations. Higher stars → higher payment + higher consumer enrolment. Significant economic incentive for MA plans to drive HEDIS performance.