Health Plan Performance
Healthcare Effectiveness Data Information Set (HEDIS®)
HEDIS is a set of standardized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA) which are the most widely used set of health care performance measures in the United States. These measures specify how organizations collect, audit and report performance information across the most pressing clinical areas, as well as dimensions of patient satisfaction and experience.
HEDIS is updated annually and consists of five domains of care. HEDIS allows for standardized measurement, reporting and accurate, objective side-by-side comparisons. The health plan uses its HEDIS results to continually improve the quality of care for its members.
Quality Assurance Reporting Requirements (QARR)
The New York State Department of Health collects health care data through an annual reporting system called Quality Assurance Reporting Requirements, or QARR. QARR measures are largely adopted from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data Information Set (HEDIS), with specific measures added to address public health issues of particular importance in New York.QARR is used to determine health plan performance on the areas of provider network, access and utilization, child and adolescent health, women's health, adult health, behavioral health and satisfaction with care.
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
CAHPS is a program administered by the Agency for Healthcare Research and Quality (AHRQ), the lead federal agency involved in developing and distributing standardized, evidence-based surveys and related tools used to assess patient experience with the United States health care system (AHRQ CAHPS Program Brief). There are many different CAHPS surveys for ambulatory care and facilities. The health plan contracts with a certified vendor to administer the CAHPS health plan survey.
The CAHPS survey gives health plan members the opportunity to report on and evaluate their health plan and tell us about their experiences with their health care. Survey topics include access to care, test preauthorization, communication with doctors and health care providers, accurate claims and service received from customer care. There are commercial, Medicaid and Medicare versions of CAHPS.Survey results are used for National Committee for Quality Assurance (NCQA) accreditation and by other regulators.