Clinical performance reviews

In addition to medical record reviews, we routinely measure clinical performance and share the results of that process with providers. The Healthcare Effectiveness Data and Information Set (HEDIS®) represents a core set of performance measures developed to understand the value of the health care dollar and how to hold a health plan accountable for its performance. Employers and the public are the primary audiences for HEDIS® reports.

HEDIS® provides a standardized set of measures that allows an apples-to-apples comparison. Primary care providers and selected consulting specialists participate in the HEDIS® process by providing specific information from members' medical records. Providers may be contacted annually in the spring to send selected information to Kaiser Permanente for review.

The data gathered by health plans across the nation is maintained by the National Committee for Quality Assurance (NCQA). We were among the first health plans in the nation to report a complete set of data using the HEDIS® methodology.

HEDIS® includes more than 90 measures across 6 domains of care:

  • Effectiveness of care
  • Access/availability of care
  • Experience of care
  • Utilization and risk adjusted utilization
  • Health plan descriptive information
  • Measures collected using electronic clinical data systems

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