10 Facts about HEDIS Reporting & Measurements
The National Committee for Quality Assurance (NCQA) created the Healthcare Effectiveness Data and Information Set (HEDIS®) in 1991. Today, HEDIS stands as one of the most widely used tools for measuring how health care plans perform. More than 90% of health plans in the United States use HEDIS to track performance, compare results, and improve care.
HEDIS relies on standardized measures, so regulators and consumers can compare health plans on equal terms.
Facts about HEDIS Reporting
HEDIS is Updated Every Year
NCQA reviews and updates HEDIS measures annually. Some measures are added, others are revised, and some are retired. This process keeps the program clinically relevant and aligned with modern health care practices.
There Are Six Domains of Care
HEDIS includes more than 90 measures grouped into six domains of care:
- Effectiveness of Care
- Access/Availability of Care
- Experience of Care
- Utilization and Risk-Adjusted Utilization
- Health Plan Descriptive Information
- Measures Reported Using Electronic Clinical Data Systems (ECDS)
Electronic Reporting Is Growing
A growing number of measures are reported using Electronic Clinical Data Systems (ECDS). This method improves accuracy and allows health plans to capture data directly from digital health records.
Data Comes from Multiple Sources
HEDIS data is collected from:
- Administrative claims and billing records
- Medical chart reviews
- Surveys such as CAHPS and the Medicare Health Outcomes Survey
- Electronic Clinical Data Systems (ECDS)
Audits Ensure Accuracy
All HEDIS results must go through an independent audit. Auditors often review midyear results so health plans can make improvements before final reporting.
HEDIS Improves Preventive Care
Measures encourage better preventive care. Examples include cancer screenings, immunizations, prenatal and postpartum care, and blood pressure control.
HEDIS Drives National Rankings
NCQA partners with U.S. News & World Report to rank health plans using HEDIS results. These rankings are released every year and help consumers evaluate plan performance.
HEDIS Feeds the State of Health Care Quality Report
Each year, NCQA publishes the State of Health Care Quality Report. This report uses HEDIS data to highlight performance trends and areas where care is improving or falling short.
Quality Compass Offers Benchmarking
NCQA’s Quality Compass tool provides detailed information on health plan submissions. It includes data across private insurance, Medicaid, and Medicare, making it a valuable resource for benchmarking.
More Than 90% of Health Plans Use HEDIS
HEDIS is nearly universal. More than 90% of U.S. health plans use it to measure care and service. This widespread use makes HEDIS the industry standard for health plan quality and accountability.
Moving Forward
HEDIS will continue to play a central role in evaluating health plan performance. With annual updates and the shift toward electronic reporting, NCQA is ensuring the program stays accurate and relevant. For health plans, strong HEDIS results mean compliance, higher rankings, and greater trust from patients and employers.