Health Plan & Provider Performance

What is HEDIS®?

Healthcare Effectiveness Data and Information Set is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The performance measures are related to many significant public health issues such as cancer, heart disease, smoking, asthma and diabetes. HEDIS is sponsored, supported and maintained by the National Committee for Quality Assurance.

Using information from NCQA's accreditation program (a rigorous and expert evaluation of how managed care plans are organized and how they operate), in combination with HEDIS data provides the most complete view of Health Plan quality available to guide choice among competing Health Plans. HEDIS provides purchasers and consumers with an unprecedented ability to evaluate the quality of different health plans along a variety of important dimensions and to make their plan decisions based on demonstrated value rather than simply on cost.

If you'd like to learn more about HEDIS, follow this link to visit the NCQA Web site.

What is QARR?

Quality Assurance Reporting Requirements was developed by the New York State Department of Health (NYSDOH) to enable consumers to evaluate the quality of health care services provided by managed care plans throughout New York state. Using QARR, you can determine how well a Health Plan performed in the areas of provider network, child and adolescent health, women's health, adults living with illness, behavioral health, and access and service.

QARR measures are largely adopted from the National Committee for Quality Assurance's (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) with the New York state-specific measures added to address public health issues of particular importance in New York.

If you’d like to learn more about QARR and see performance of Health Plans in New York State, follow this link to visit the New York state DOH Web site.

What is CAHPS®?

The term CAHPS refers to a comprehensive and evolving family of surveys that ask consumers and patients to evaluate the interpersonal aspects of health care. CAHPS initially stood for the Consumer Assessment of Health Plans Surveys, but as the products have evolved beyond Health Plans, CAHPS now stands for Consumer Assessment of Health Providers and Systems. CAHPS surveys probe those aspects of care for which consumers and patients are the best or only source of information and those aspects of care that consumers and patients have identified as being important.

Items from the CAHPS survey are used to calculate a set of six composite scores and four overall ratings that are then reported by Health Plans, and are used by NCQA for accreditation processes and report cards. Each composite score is made up of plan level aggregations of member responses to two or more CAHPS questions. The six composite scores measured are: Getting Needed Care, Getting Care Quickly, How Well Doctors Communicate, Courteousness of Office Staff, Customer Service and Claims Processing. The four overall ratings questions ask members to rate their personal doctor, the specialist they have seen in the last 12 months, the health care they have received in the last 12 months and their Health Plan.

NCQA and the Centers for Medicare & Medicaid Services conduct CAHPS surveys annually for managed care members.

For more information on CAHPS, follow this link to visit the CAHPS Web site.