4 Metrics Used to Measure the Performance of a Health Plan

HEDIS or Healthcare Effectiveness Data and Information Set is used by individuals and employers to measure the quality of a health plan. It is used to measure the quality of service and care that health plans provide to their members.

📌 How does HEDIS Work?

Here is the HEDIS meaning explained: Healthcare Effectiveness Data and Information Set (HEDIS) uses various metrics across six different care areas to rate health plans. Health plans collect data regarding their performance on certain types of care or services; for example, how many children are vaccinated. HEDIS is used by health plans to see which areas are performing well and where improvements need to be made. HEDIS measures and metrics can also be used by consumers or employers in the process of choosing a health plan.

📌 HEDIS Measures

To measure the effectiveness of a certain health plan, HEDIS includes several measures and metrics. This includes the effectiveness of care, which covers areas such as screening and prevention, respiratory conditions, diabetes, cardiovascular conditions, musculoskeletal conditions, behavioral health, overuse and appropriateness, medication management, care coordination, and more. Other HEDIS measures include the access and availability of care, utilization of the health plan, risk-adjusted utilization, and measures that are reported using electronic clinical data systems.

📌 Other Metrics for Evaluating Health Plans

1. Overall Cost

For employers who provide health plans, in particular, understanding their needs and ensuring that meeting them is a priority can be helpful when it comes to determining if employers and employees are getting the most from the health plans. In the workplace, health plans need to be affordable to both the employer and the employees. While going with the cheapest plan might seem like the best way to cut costs, it is not always the best way to ensure good value.

2. User Health and Wellbeing

As health plans are not always cheap, it is important that the plan is worth the cost for ensuring that the user stays happy and healthy. In the process of selecting a plan, it is a good idea to look for one that provides access to a wide range of both primary care providers and specialists.

3. Benefits Quality

Another metric to consider when choosing a health plan as an employer is the quality of the benefits offered. While most employers are concerned with keeping expenses low, the good news is that a good health plan doesn’t need to sacrifice the benefits on offer in return for spending less. Choose a health plan that provides valuable care options and has lots of benefits for users.

4. Technology

Finally, technology options are becoming a more commonly used metric when it comes to measuring the effectiveness of a health plan. More technology offerings such as telemedicine can be useful in expanding the user’s access to care and broadening the network of healthcare professionals that they are able to access.

Health plans vary when it comes to what they offer. Along with HEDIS, there are various other metrics that you may want to consider if you are choosing a health plan for yourself, your employees, or somebody else.