The 130th Annual Meeting of APHA

Abstract #45071

Lok Wong, MHS, Measures Development, National Committee for Quality Assurance, 2000 L Street, NW, Suite 500, Washington D.C, DC 20036, 202 955 1784, wong@ncqa.org

The Health Plan Employer Data and Information Set, HEDIS ^® constitutes the major performance measurement tool for the managed care environment that aids 65 million Americans in selecting and assessing their health plan based on quality. To provide comparative health care quality information for public reporting purposes, potential new HEDIS measures have to meet stringent clinical and methodological criteria.

This paper will present the challenges and difficulties that the National Committee for Quality Assurance (NCQA) has experienced in developing performance measures that meet the stringent requirements established by the HEDIS. The aim is to uncover potential lessons from past and current experiences that can be applied to future development of performance measures for public reporting and accountability. Case studies of potential measures that failed to meet the HEDIS criteria, or continue to pose methodological challenges and have not yet been adopted into HEDIS will be presented. The conceptual logic, initial technical specifications, and some field-test results of measurement efforts in geriatrics, antibiotic use, access and service areas will be examined. By presenting the obstacles encountered, the necessary conditions and process for adoption into the HEDIS instrumentation will be elucidated.

The lessons learned will be of interest to health plans, physicians, users of HEDIS data, researchers and policy-makers who want to understand the unique challenges of comparative performance measurement in various clinical conditions and dimensions of quality.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

• List several examples of attempted performance measures and describe the reasons for their lack of success to be adopted into HEDIS
• Define the HEDIS criteria and articulate the key conditions for the successful development of a HEDIS performance measure.
• Apply the HEDIS criteria to other areas in order to assess their potential to be developed into performance measures for public reporting and accountability.

Keywords: Performance Measurement, Health Care Quality

Related Web page: www.ncqa.org

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: National Committee for Quality Assurance (NCQA) - a not-for-profit organization committed to assessing, reporting on and improving the quality of care provided by organized health care delivery systems.
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment at NCQA