Quality assurance and HEDIS®

AllWays Health Partners’ behavioral health partner Optum provides a quality assurance (QA) toolkit for primary care providers (PCPs). This toolkit was designed to explain the substance use disorders and depression measures of HEDIS® to PCPs and give recommendations for meeting these measures. HEDIS stands for Healthcare Effectiveness Data and Information Set, describing a set of performance measures for both behavioral and physical health conditions. The intent is for purchasers and consumers to use HEDIS to compare and evaluate health plans easily.  Not only that, HEDIS sets a standard for the quality of care that patients should be receiving. The National Committee for Quality Assurance (NCQA) uses HEDIS to evaluate PCPs, health plans, and Managed Behavioral Healthcare Organizations.

 

HEDIS Measures

Optum’s QA toolkit focus on addressing the needs of patients with behavioral health and substance abuse disorders. In addition to measures centered around these conditions, HEDIS has many others oriented towards physical health, such as immunizations, diabetes, mammography, cholesterol, high blood pressure and more. In a previous blog post of ours about identifying depression in the primary care setting, we mention the HEDIS Antidepressant Medication Management (AMM) measures. These measures require that PCPS support patients who have been newly diagnosed with depression or treated with antidepressants by helping them improve antidepressant medication adherence. This involves educating the patient on the importance of sticking with their medication and setting up follow-up appointments with them to make sure they’re keeping up.

 

Why does quality assurance matter?

The HEDIS measures are a guide to high-quality level of care. By aiming to meet the measures of HEDIS, PCPs can be sure that they’re providing the best care to their patients. Use Optum’s QA toolkit to help you meet these measures. Improvement of HEDIS measures leads to better patient outcomes.

 

More info on HEDIS®

AllWays Health Partners HEDIS Tip Sheet 2019

 

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