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McLaren Health Plan (MHP) submits claims and medical review data to the National Committee for Quality Assurance (NCQA). This NCQA reporting requirement defined as the Health Care Effectiveness Data and Information Set (HEDIS) is one of the measurements utilized to assess how well MHP is delivering health care. NCQA is an independent not-for-profit organization dedicated to measuring the quality of health care.
Many HEDIS measures may only include a small number of a practitioner’s patients. This is due to a continuous enrollment requirement in the specifications, and sampling of the eligible population.
Some of the HEDIS measures can only be calculated by administrative results (which is claim data submitted by a practitioner) and some measures can be calculated through the hybrid method (which is a combination of claim submissions and medical record review).
To help physicians better understand the HEDIS measures, we have included a summary table with the Quality Indicator that is being measured. We hope this information is useful. If you have any questions regarding HEDIS specifications, please contact McLaren Health Plan at (810) 733-9524.