For nearly two decades, Better Health Group has been a leader in value-based care and operating top-rated primary care clinics. Our network of owned and independent clinics leverage our model to improve care for both Medicare Advantage (MA) and Traditional Medicare patients. Now, the Centers for Medicare & Medicaid Services (CMS) has ranked Better Health Group in the top 5% of Medicare Shared Savings Program (MSSP), Accountable Care Organizations (ACOs) for performance year 2023.
At a time when independent clinics face mounting challenges, our providers are exceeding CMS quality goals and maximizing shared savings revenue, in every state in which we operate—Florida, Alabama, Georgia, Texas, Oklahoma, and Tennessee.
What Are HEDIS Measures?
HEDIS (Healthcare Effectiveness Data and Information Set) is a standardized set of performance measures used to evaluate the quality of care delivered by health plans and the provider organizations they contract with. Developed and maintained by the National Committee for Quality Assurance (NCQA), HEDIS is used by more than 90% of the nation's health plans, making it one of the most influential quality measurement tools in U.S. healthcare.
For independent practices participating in value-based care, HEDIS isn't background noise. It's often the scorecard that determines quality bonuses, Star Ratings performance, and in some cases, eligibility to remain in a payer's network.
What Do HEDIS Measures Actually Track?
HEDIS measures span several clinical domains, including:
- Preventive screenings — breast, cervical, and colorectal cancer screening
- Chronic disease management — blood pressure control, glycemic status for patients with diabetes, kidney health evaluations
- Behavioral health — depression screening and follow-up, alcohol use screening
- Access and experience — timeliness of prenatal care, well-child visits, member satisfaction
Each measure defines a specific patient population (the "denominator") and the action or outcome that closes the gap (the "numerator"). A missed screening, an undocumented lab value, or a claim that was never submitted can all cause a compliant visit to score as a gap.
How Are HEDIS Measures Collected?
NCQA recognizes three primary collection methods:
- Administrative data — claims and encounter data already submitted to the health plan
- Hybrid data — administrative data supplemented by manual medical record review
- Electronic Clinical Data Systems (ECDS) — data pulled directly from EHRs, health information exchanges, and case management systems
NCQA has been steadily transitioning select measures to ECDS-only reporting, which removes the annual chart-retrieval process for those measures and shifts compliance entirely to structured, electronically submitted data. That shift raises the stakes on clean documentation and timely coding at the point of care, since there's no longer a manual review to catch what wasn't captured electronically.
Why HEDIS Matters for Value-Based Care
In fee-for-service medicine, a missed screening is a missed opportunity for the patient. In value-based care, it's also a missed measure, one that can directly affect a practice's shared savings, quality bonus, or standing in an ACO. Practices that treat HEDIS as a byproduct of good care, rather than a separate administrative task, tend to close gaps more consistently because the workflow and the documentation happen at the same time, in the same visit.
FAQ
1. What does HEDIS stand for? Healthcare Effectiveness Data and Information Set.
2. Who creates and owns HEDIS measures? NCQA (the National Committee for Quality Assurance) develops, owns, and updates HEDIS measures annually.
3. Are HEDIS measures the same for every health plan? The measure specifications are standardized, but which measures apply, and how they're weighted, can vary by plan, product line (Medicaid, Medicare, Marketplace), and contract.
What Are HEDIS Measures?
HEDIS (Healthcare Effectiveness Data and Information Set) is a standardized set of performance measures used to evaluate the quality of care delivered by health plans and the provider organizations they contract with. Developed and maintained by the National Committee for Quality Assurance (NCQA), HEDIS is used by more than 90% of the nation's health plans, making it one of the most influential quality measurement tools in U.S. healthcare.
For independent practices participating in value-based care, HEDIS isn't background noise. It's often the scorecard that determines quality bonuses, Star Ratings performance, and in some cases, eligibility to remain in a payer's network.
What Do HEDIS Measures Actually Track?
HEDIS measures span several clinical domains, including:
- Preventive screenings — breast, cervical, and colorectal cancer screening
- Chronic disease management — blood pressure control, glycemic status for patients with diabetes, kidney health evaluations
- Behavioral health — depression screening and follow-up, alcohol use screening
- Access and experience — timeliness of prenatal care, well-child visits, member satisfaction
Each measure defines a specific patient population (the "denominator") and the action or outcome that closes the gap (the "numerator"). A missed screening, an undocumented lab value, or a claim that was never submitted can all cause a compliant visit to score as a gap.
How Are HEDIS Measures Collected?
NCQA recognizes three primary collection methods:
- Administrative data — claims and encounter data already submitted to the health plan
- Hybrid data — administrative data supplemented by manual medical record review
- Electronic Clinical Data Systems (ECDS) — data pulled directly from EHRs, health information exchanges, and case management systems
NCQA has been steadily transitioning select measures to ECDS-only reporting, which removes the annual chart-retrieval process for those measures and shifts compliance entirely to structured, electronically submitted data. That shift raises the stakes on clean documentation and timely coding at the point of care, since there's no longer a manual review to catch what wasn't captured electronically.
Why HEDIS Matters for Value-Based Care
In fee-for-service medicine, a missed screening is a missed opportunity for the patient. In value-based care, it's also a missed measure, one that can directly affect a practice's shared savings, quality bonus, or standing in an ACO. Practices that treat HEDIS as a byproduct of good care, rather than a separate administrative task, tend to close gaps more consistently because the workflow and the documentation happen at the same time, in the same visit.
FAQ
1. What does HEDIS stand for? Healthcare Effectiveness Data and Information Set.
2. Who creates and owns HEDIS measures? NCQA (the National Committee for Quality Assurance) develops, owns, and updates HEDIS measures annually.
3. Are HEDIS measures the same for every health plan? The measure specifications are standardized, but which measures apply, and how they're weighted, can vary by plan, product line (Medicaid, Medicare, Marketplace), and contract.
What Are HEDIS Measures?
HEDIS (Healthcare Effectiveness Data and Information Set) is a standardized set of performance measures used to evaluate the quality of care delivered by health plans and the provider organizations they contract with. Developed and maintained by the National Committee for Quality Assurance (NCQA), HEDIS is used by more than 90% of the nation's health plans, making it one of the most influential quality measurement tools in U.S. healthcare.
For independent practices participating in value-based care, HEDIS isn't background noise. It's often the scorecard that determines quality bonuses, Star Ratings performance, and in some cases, eligibility to remain in a payer's network.
What Do HEDIS Measures Actually Track?
HEDIS measures span several clinical domains, including:
- Preventive screenings — breast, cervical, and colorectal cancer screening
- Chronic disease management — blood pressure control, glycemic status for patients with diabetes, kidney health evaluations
- Behavioral health — depression screening and follow-up, alcohol use screening
- Access and experience — timeliness of prenatal care, well-child visits, member satisfaction
Each measure defines a specific patient population (the "denominator") and the action or outcome that closes the gap (the "numerator"). A missed screening, an undocumented lab value, or a claim that was never submitted can all cause a compliant visit to score as a gap.
How Are HEDIS Measures Collected?
NCQA recognizes three primary collection methods:
- Administrative data — claims and encounter data already submitted to the health plan
- Hybrid data — administrative data supplemented by manual medical record review
- Electronic Clinical Data Systems (ECDS) — data pulled directly from EHRs, health information exchanges, and case management systems
NCQA has been steadily transitioning select measures to ECDS-only reporting, which removes the annual chart-retrieval process for those measures and shifts compliance entirely to structured, electronically submitted data. That shift raises the stakes on clean documentation and timely coding at the point of care, since there's no longer a manual review to catch what wasn't captured electronically.
Why HEDIS Matters for Value-Based Care
In fee-for-service medicine, a missed screening is a missed opportunity for the patient. In value-based care, it's also a missed measure, one that can directly affect a practice's shared savings, quality bonus, or standing in an ACO. Practices that treat HEDIS as a byproduct of good care, rather than a separate administrative task, tend to close gaps more consistently because the workflow and the documentation happen at the same time, in the same visit.
FAQ
1. What does HEDIS stand for? Healthcare Effectiveness Data and Information Set.
2. Who creates and owns HEDIS measures? NCQA (the National Committee for Quality Assurance) develops, owns, and updates HEDIS measures annually.
3. Are HEDIS measures the same for every health plan? The measure specifications are standardized, but which measures apply, and how they're weighted, can vary by plan, product line (Medicaid, Medicare, Marketplace), and contract.