The Health Plan Employer Data and Information Set (HEDIS)* is an evolving set of criteria for collecting data on health maintenance organizations (HMOs). Initially designed by a consortium of employers and health plan representatives, it is owned by the National Committee for Quality Assurance (NCQA) and becomes more complex each year. As of 1999, HEDIS results are being used in NCQA HMO accreditation scoring. This article describes the changes in HEDIS for 1999, some possible changes for 2000, and how a health plan can use HEDIS to its advantage when preparing to meet NCQA accreditation standards.

Historically, employers have asked health plans to measure performance in terms of quality, utilization, satisfaction, and cost. As organizations collected these data, employers realized that rarely were all the data comparable. Several employers, such as Xerox Corporation, Digital Equipment Corporation, and Bull HN Information Systems, Inc., agreed to work together to create reporting criteria that would standardize measurement. This collaboration resulted in the Health Plan Employer Data Information Set (HEDIS) criteria. This article reviews some of the implementation issues and decisions that a plan must resolve to gather accurate HEDIS data.

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