10 Facts about HEDIS Reporting and Measurements

The Healthcare Effectiveness Data and Information Set (HEDIS) provides standardized measures that health plans use to track how well members receive needed care. More than 90% of U.S. health plans rely on these measures to compare performance, identify gaps in care, and improve outcomes. More than 235 million people are enrolled in plans that report HEDIS results.

As healthcare has shifted toward timely diagnoses, routine wellness care, and financial incentives for stable or enhanced member health, HEDIS has grown in importance. It now supports everything from preventive screenings to chronic disease management and plays a key role in quality reporting and reimbursement. It’s also a central part of strategic planning for both payers and providers.

Facts About HEDIS Reporting

Here are ten updated facts about HEDIS you should know.

HEDIS covers many measures. It includes scores on more than 90 standardized care and service performance metrics across domains such as effectiveness of care, access, utilization, and experience.

HEDIS is used by most plans. More than 90% of U.S. health plans report HEDIS results.

HEDIS enables apples-to-apples comparisons. Bec

use the measures are standardized and audited, HEDIS allows comparisons across health plans, regions, and service lines.

Measures reporting depends on multiple sources for data. Data used in HEDIS reporting comes from administrative sources (claims), pharmacy records, lab results, electronic health records (EHRs) and more.

Performance on measures influence provider and plan incentives. Standardized and audited measures allow health plans to compare performance across plans, regions, and service lines.

Prevention and chronic care take center stage. Many HEDIS measures focus on preventive care, such as cancer screening, and chronic disease management like diabetes or hypertension.

Accreditation and public reporting are tied in. The National Committee for Quality Assurance (NCQA) leverages HEDIS results for accreditation, with results used in public reporting campaigns.

It helps identify performance gaps and target improvement. The reporting data tell plans where they are under performing so they can design programs to close gaps. HEDIS is shifting with value-based care. As organizations move from fee for service to outcome-based models, this reporting remains relevant. Broader population health, cost, and utilization metrics now complement it.

The Shift to Values-Based Care

Value-based care offers potential benefits to patients and providers by focusing on rewarding quality outcomes Data generated with the reporting can provide the standardized metrics that measure that level of quality.

Research has shown that the potential for significant savings is high. For example, Humana Inc.’s ’s 2024 Value-Based Care Report offers the report found that Humana’s Medicare Advantage (MA) value-based arrangements generated an estimated $11 billion in medical cost savings in 2023. That’s about 26% in savings compared to what costs would have been under traditional models.

Within those value-based arrangements, MA members saw approximately 12% fewer emergency room visits and 7% fewer hospital admissions. MA members in value-based arrangements also experienced almost a third fewer inpatient admissions in 2023 versus those in traditional Medicare.

In a study of senior-focused primary care organizations under value-based models, patients received 17% more primary care visits, Black patients had 39% more visits, and low-income beneficiaries had 21% more visits compared to others. That same study found 6% fewer hospitalizations and a 10% lower likelihood of 30-day readmission among patients who were admitted

HEDIS reporting remains one of the most trusted tools for improving healthcare quality and accountability. By tracking what matters, including healthcare access and effectiveness, HEDIS gives payers and providers a shared language for better care.

Turning HEDIS Metrics into Action with FRG

For most organizations, the challenge isn’t just reporting HEDIS, it’s turning those metrics into operational decisions that improve care and financial performance.

AccuReports from Financial Recovery Group (FRG) brings together complex claims, medical economics, and quality data in a drillable, web-based environment, allowing users to move quickly from plan-level metrics into group, practice, and member detail.

With FRG’s analytics and advisory support, health plans and provider organizations can:

• Monitor HEDIS and other quality measures alongside utilization and cost trends.
• Identify high-value care gaps and prioritize outreach where it will have the biggest impact.
• Align quality initiatives with risk adjustment and revenue targets to protect margins in value-based contracts.
• Provide clear, actionable reports to clinical leaders, care managers, and network providers.

FRG combines healthcare financial intelligence, technology, and hands-on expertise to help clients make their data easier to understand and act on.

If your organization is looking to strengthen HEDIS performance, close care gaps, or better connect quality results to financial outcomes, FRG can help. Contact FRG to learn how AccuReports and FRG’s expert services can support your quality and value-based care strategy.