Definition
HEDIS
HEDIS (the Healthcare Effectiveness Data and Information Set) is a standardized set of performance measures, maintained by the NCQA, that most US health plans use to report quality of care. It tracks things like cancer screenings, diabetes and blood-pressure control, and childhood immunizations, and the results drive plan ratings and value-based reimbursement.
Definition
What HEDIS is
HEDIS is a set of quality measures published by the National Committee for Quality Assurance and reported by most commercial, Medicare, and Medicaid plans. Each measure defines a numerator and denominator, for example, the share of eligible patients who completed a colorectal cancer screening, so plans and provider groups can be compared on the same footing.
Because HEDIS results feed Medicare Star Ratings and value-based contracts, closing HEDIS gaps has direct financial stakes. A care gap is simply an eligible patient who is missing a required service; the work is finding those patients and getting the screening, visit, or medication completed and documented before the measurement year closes.
That closure work is mostly outreach. Rivvi runs HEDIS gap-closure programs as real conversations over voice and text, calling the patients due for a mammogram, an A1c check, or a wellness visit, booking them, and writing the outcome back, from a branded number and inside TCPA rules.
HEDIS, answered
- What does HEDIS stand for?
- HEDIS stands for the Healthcare Effectiveness Data and Information Set. It is a standardized set of quality-of-care measures maintained by the NCQA and reported by most US health plans, so purchasers and regulators can compare plans on the same defined metrics.
- How is a HEDIS care gap closed?
- A HEDIS gap is closed when an eligible patient completes the required service, such as a screening, wellness visit, or medication fill, and it is documented before the measurement year ends. In practice that means identifying due patients and reaching them with outreach that books the visit and captures the result.
- How does HEDIS relate to Star Ratings?
- Many Medicare Star Ratings measures are drawn from HEDIS, so a plan's HEDIS performance directly shapes its Star Rating. Higher stars unlock quality bonus payments and stronger enrollment, which is why plans and their provider partners invest heavily in closing HEDIS gaps.
- How does this help with quality measures and risk adjustment?
- Rivvi works your attributed panel to close the gaps your contracts measure: it books the AWVs and screenings that satisfy HEDIS-style quality measures and anchor accurate risk capture, then writes the completed visit back to your system of record so the measure and the documentation both land.