According to the National Committee for Quality Assurance, the Health Employer Data & Information Set is used by a vast majority of American health insurance companies to “measure performance on important dimensions of care and service” (NCQA, 2014). Specifically, HEDIS is used to compare the performance of individual health plans’ ability to determine where it would be useful to improve benefits depending on the treatment and diagnostic needs of their customer base. For example, these plans would rather accommodate the treatment and diagnosis of disease that have a high impact on the population; in situations where early diagnosis would prevent repeated visits to a doctor, health plans aim to create better screening options. As such, the medical situations that are regularly reviewed by this industry include the use of asthma medication, controlling high blood pressure, early detecting of breast cancer through screening, and assessment of child and adult weight and BMI.
According to the Agency for Healthcare Research and Quality, there are different established healthcare quality measures for adults and children (AHRQ, n.d). This is an intuitive assumption in nursing because the characteristics that are frequently used to diagnose adult disease and their respective treatments differ can in symptoms and dose among various patient age groups. While adult care under HEDIS is focused on prevention and treatment, child care under HEDIS is primarily concerned with preventative and well care, descriptive measures that will aid researchers in understanding childhood disease, how frequently children use plan services, care for selected chronic conditions, and perceptions of care and quality of life.
Ultimately, HEDIS is useful because it allows insurance companies to have a greater understanding of their patient base and give them the ability to use this information to remain competitive, which in turn yields better patient care. In addition, this data allows us to understand more about the epidemiology of human health, and we can also use this data to determine which illnesses we should be worried about in the present.
AHRQ. (n.d.). HEDIS®: Health Plan Employer Data and Information Set. Retrieved from http://www.ahrq.gov/legacy/chtoolbx/measure4.htm
NCQA. (2004). HEDIS 2004. Retrieved from http://www.ncqa.org/HEDISQualityMeasurement.aspx