What is HEDIS®?

Adults’ access to preventive/ambulatory health services (AAP)

The percentage of members 20 years and older who had an ambulatory or preventive care visit during the measurement year.

Follow-up care for children prescribed ADHD medication (ADD)

The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported:

• Initiation Phase. The percentage of members 6–12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner with prescribing authority during the 30-day Initiation Phase.
• Continuation and Maintenance (C&M) Phase. The percentage of members 6–12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Breast cancer screening (BCS)

The percentage of women 50 to 74 years of age who had a mammogram to screen for breast cancer.

Controlling high blood pressure (CBP)

The percentage of members 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled during the measurement year based on the following criteria:

• Members 18 to 59 years of age whose BP was <140/90 mm Hg 
• Members 60 to 85 years of age with a diagnosis of diabetes whose BP was <140/90 mm Hg 
• Members 60 to 85 years of age without a diagnosis of diabetes whose BP was <150/90 mm Hg 

A single rate is reported and is the sum of all three groups.

Cervical cancer screening (CCS)

The percentage of women 21 to 64 years of age who were screened for cervical cancer using any of these criteria:

• Women 21 to 64 years of age who had cervical cytology performed within the last three years
• Women 30 to 64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last five years
• Women 30 to 64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) cotesting within the last five years 

Comprehensive diabetes care (CDC)

The percentage of members 18 to 75 years of age with diabetes (type 1 and type 2) who had each of the following:

• Hemoglobin A1c (HbA1c) testing
• HbA1c control (<8.0%)
• Medical attention for nephropathy
• BP control (<140/90 mm Hg)
• Eye exam (retinal) performed

Childhood immunization status combo 10 (CIS)

The percentage of children 2 years of age who had the following vaccines by their second birthday:

Combination 10: Four diphtheria, tetanus and acellular pertussis (DTaP), three polio (IPV), one measles, mumps and rubella (MMR), three haemophilus influenza type B (HiB), three hepatitis B (HepB), one chicken pox (VZV), four pneumococcal conjugate (PCV), one hepatitis A (HepA), two or three rotavirus (RV), and two influenza (flu)

The measure calculates a rate for each vaccine individually and separate combination rates.

Follow-up after emergency department visit for alcohol and other drug abuse or dependence (FUA)

The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit for AOD. Two rates are reported:

• The percentage of ED visits for which the member received follow-up within 30 days of the ED visit
• The percentage of ED visits for which the member received follow-up within 7 days of the ED visit

Follow-up after hospitalization for mental illness (FUH)

The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner. Two rates are reported:

• The percentage of discharges for which the member received follow-up within 30 days of discharge
• The percentage of discharges for which the member received follow-up within 7 days of discharge

Follow-up after emergency department visit for mental illness (FUM)

The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness. Two rates are reported:

• The percentage of ED visits for which the member received follow-up within 30 days of the ED visit
• The percentage of ED visits for which the member received follow-up within 7 days of the ED visit

Immunizations for adolescents combo 2 (IMA)

The percentage of adolescents 13 years of age who had one dose of meningococcal conjugate vaccine; one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine; and three doses of the human papillomavirus (HPV) vaccine by their 13th birthday. The measure calculates a rate for each vaccine and two combination rates.

Prenatal and postpartum care (PPC)

The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care: 

• Timeliness of prenatal care: The percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization. 
• Postpartum care: The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.

Weight assessment and counseling for nutrition and physical activity for children/adolescents (WCC)

The percentage of members 3 to 17 years of age who had an outpatient visit with a Primary Care Practitioner (PCP) or OB/GYN and who had evidence of the following during the measurement year:

• BMI percentile documentation
• Counseling for nutrition
• Counseling for physical activity

Child and adolescent well-care visits (WCV)

Children and teenagers 3 to 21 years of age who had a well visit with a PCP or OB/GYN during the measurement year.

Well-child visits in the first 30 months of life (W30)

The percentage of members who had the following number of well-child visits with a PCP during the last 15 months. The following rates are reported:

• Well-child visits in the first 15 months. Children who turned 15 months old during the measurement year: Six or more well-child visits.
• Well-child visits for age 15 months to 30 months. Children who turned 30 months old during the measurement year: two or more well-child visits.