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What is HEDIS used for?
The National Committee for Quality Assurance (NCQA) coordinates HEDIS testing and scorekeeping. The Centers for Medicare & Medicaid Services uses HEDIS scores to monitor a health plan’s performance. More than 90% of American health plans use HEDIS scores to compare how well the plan performs in areas like:
- Quality of care
- Access to care
- Member satisfaction with the plan and providers
HEDIS Support
We have developed a program to help address our members' health care needs that align with HEDIS measures. Aetna Better Health of Virginia has partnered with mPulse to provide a digital solution for conducting outreach to members for care/service reminders and education. The goal of this program is to improve quality metrics, including HEDIS measures, as well as member health outcomes, via a digital communication solution that contacts the member via text message. Aetna provides all funding for this program. Therefore, there is no risk nor cost to providers who participate.
If you are interested in learning more and participating in the program, please reach out to our Quality Management department at QualityManagementPrograms@Aetna.com.
HEDIS education materials
Here are some helpful links to get started with:
- Prenatal/Postpartum Care (PPC): A HEDIS Tool for Provider (PDF)
- Quality Toolkit for Providers (PDF)
- Oral Health Care Tips for Pediatricians (PDF)
- Oral Health Care Tips for Prenatal Providers (PDF)
- Provider training videos
- Provider HEDIS Reference Tool (PDF)
- HEDIS tips for primary care physicians (PDF)
- HEDIS tips for pediatricians (PDF)
- CPT II Codes and HEDIS Toolkit (PDF)
- Social Determinants of Health Toolkit (PDF)
- EPSDT Toolkit (PDF)
- CAHPS: A Helpful Guide for Providers (PDF)
- Other training materials
- (AIS-E) Adult Immunization Status (PDF)
- (APP) Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (PDF)
- (BPD) Blood Pressure Control (PDF)
- (COL-E) Colorectal Cancer Screening (PDF)
- (DSF-E) Depression Screening and Follow-Up for Adolescents and Adults (PDF)
- (EED) Eye Exam for Patient with Diabetes (PDF)
- (FUA) Follow Up After ED for Alcohol and Other Drug Abuse Dependence (PDF)
- (FUI) Follow Up After High-Intensity Care or Substance Use Disorder (PDF)
- (FUM) Follow Up After ED for Mental Illness (PDF)
- (GSD) Glycemic Status Assessment for Patients with Diabetes (PDF)
- (IET) Alcohol or Drug Abuse or Dependence Treatment Engaged (PDF)
- (KED) Kidney Health Evaluation for Patients with Diabetes (PDF)
- (LBP) Use of Imaging Studies for Low Back Pain (PDF)
- (MSC) Medical Assistance with Smoking and Tobacco Use Cessation (PDF)
- (POD) Pharmacotherapy for Opioid Use Disorder (PDF)
- (PPC, PDS-E, PRS-E) Prenatal Postpartum Care (PDF)
- (RDM) Race Ethnicity Diversity of Membership (PDF)
- (SPC) Statin Therapy for Patients with Cardiovascular Disease (PDF)
- (AAP) Access and availability of care (PDF)
- (SAA) Adherence to antipsychotic medications for individuals with schizophrenia (PDF)
- (AMB) Ambulatory care (PDF)
- (AMM) Antidepressant medication management (PDF)
- (CWP) Appropriate testing for pharyngitis (PDF)
- (URI) Appropriate testing for upper respiratory infection (PDF)
- (AMR) Asthma medication ratio (PDF)
- (AAB) Avoidance of antibiotic treatment for acute bronchitis/bronchiolitis (PDF)
- (BCS) Breast cancer screening (PDF)
- (SMC) Cardiovascular monitoring for people with cardiovascular disease and schizophrenia (PDF)
- (CCS) Cervical cancer screening (PDF)
- (WCV) Child and adolescent well care visits (PDF)
- (CIS) Childhood immunization status (PDF)
- (CHL) Chlamydia screening in women (PDF)
- (CBP) Controlling high blood pressure (PDF)
- (DEV) Developmental screening in the first three years of life (PDF)
- Diabetes care (PDF)
- (SMD) Diabetes monitoring for people with diabetes and schizophrenia (PDF)
- (FUH) Follow-up after hospitalization for mental illness (PDF)
- (ADD) Follow-up care for children prescribed ADHD medication (PDF)
- (IMA) Immunizations for adolescents (PDF)
- (LSC) Lead screening in children (PDF)
- (APM) Metabolic monitoring for children and adolescents on antipsychotics (PDF)
- (PBH) Persistence of Beta-blocker treatment after a heart attack (PDF)
- (PDE) Pharmacotherapy management of COPD exacerbation (PDF)
- (PCR) Plan all-cause readmissions (PDF)
- (PPC) Prenatal and postpartum care (PDF)
- (PSC) Statin therapy for patients with cardiovascular disease (PDF)
- (SPD) Statin therapy for patients with diabetes (PDF)
- (WCC) Weight assessment and counseling for nutrition and physical activity for children/adolescents (PDF)
- (W30) Well-child visits in the first 30 months of life (PDF)
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).