HEDIS FOUNDATIONS
This standardized measurement framework focuses on documented outcomes rather than effort or intent.
What is HEDIS?
This type of HEDIS measure relies entirely on structured data such as claims and encounters.
What is an administrative measure?
This maternal health measure family includes more than one rate rather than a single combined requirement.
What is Prenatal and Postpartum Care (PPC)?
HEDIS results are most often evaluated using this type of comparative ranking rather than pass/fail thresholds.
What is the 90th percentile?
Most HEDIS improvement strategies are designed to increase this component of the measure equation.
What is the numerator?
This organization develops, maintains, and updates HEDIS measures annually using evidence-based guidelines.
What is NCQA?
This reporting approach allows medical record review to supplement administrative data when services are not visible in claims.
What is hybrid reporting?
This behavioral health measure evaluates whether follow-up care occurs within defined timeframes after discharge.
What is Follow-Up After Hospitalization for Mental Illness (FUH)?
This percentile is commonly viewed as indicative of best-in-class performance
What is the 90th percentile?
This operational approach is more likely to produce sustainable HEDIS gains than one-time outreach efforts.
What are embedded or sustained workflows?
HEDIS is most valuable to states because it allows plans to be compared using this key characteristic.
What is standardization (or standardized measurement)?
This measure type introduces additional operational complexity due to staffing, vendor support, or provider engagement needs.
What is a hybrid measure?
This diabetes-related measure replaced components that were previously reported under a broader composite.
What is Glycemic Status for Patients with Diabetes (GSD)?
States tend to value this performance pattern more than isolated year-to-year spikes.
What is consistent or sustained performance over time?
Administrative measure performance is especially sensitive to this aspect of provider behavior.
What is accurate and timely coding or claims submission?
True or False: HEDIS is designed to measure the quality of individual providers rather than health plan performance.
What is False?
True or False: Measures that allow chart review must always include chart review to be reported.
A: What is False?
Eligibility criteria such as age range or life stage are critical because they define this part of a HEDIS measure.
What is the denominator?
Benchmarks are not universal; instead, they are typically specific to this aspect of HEDIS evaluation.
What is the individual measure?
Survey-based measure performance is heavily influenced by member engagement and this additional factor.
What are response rates?
From a state’s perspective, HEDIS primarily functions as this type of tool during procurement and oversight.
What is a risk-reduction or validation tool?
Survey-based HEDIS measures differ from clinical measures because they primarily assess this dimension of care.
What is patient experience?
Performance may not count toward a HEDIS measure even if care occurred when this requirement is not met.
What is the required timing or measurement window?
When reviewing bids, states often use HEDIS results to validate or challenge information found in this part of an RFP.
What is the Quality or Performance section?
Strong HEDIS performance often signals this broader organizational capability to state evaluators
What is operational maturity?