What Is HEDIS?
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS measures are used by more than 90 percent of U.S. health plans to evaluate care quality and service performance across a standardized set of clinical and operational domains.
Key Measure Categories
HEDIS encompasses over 90 measures across six domains of care: effectiveness of care, access and availability of care, experience of care, utilization and relative resource use, health plan descriptive information, and measures reported using electronic clinical data systems. Common measures include breast cancer screening rates, controlling high blood pressure, comprehensive diabetes care, and follow-up after hospitalization for mental illness.
Why HEDIS Matters for Engagement
HEDIS performance directly influences CMS Star Ratings, which in turn drive quality bonus payments and competitive positioning for Medicare Advantage plans. Proactive member engagement programs — including targeted outreach for preventive screenings, medication adherence support, and care gap closure — are among the most effective levers health plans have to improve HEDIS scores.