HEDIS and Star Rating tip sheets
Point32Health — the parent company of Harvard Pilgrim Health Care and Tufts Health Plan — developed these tips sheets to aid your practice in optimizing HEDIS measures and Star Ratings.
HEDIS® is one of health care’s most widely used performance assessment and improvement tools, and HEDIS measures offer insight on important aspects of clinical care and service. Star Ratings are used by the Centers for Medicare and Medicaid Services (CMS) to evaluate Medicare health and drug plans, and aid members in selecting the best health plan for them.
The best practices highlighted on our tip sheets can support you by ensuring that the data reported accurately reflects your practice’s performance on these measures and by identifying opportunities to improve patient care.
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Discover handy HEDIS tips
- Adult Immunization Status (AIS-E)
- Asthma Medication Ratio (AMR)
- Child and Adolescent Well-Care Visits (WCV)
- Colorectal Cancer Screening (COL)
- Controlling High Blood Pressure (CBP)
- Eye Exam for Patients with Diabetes (EED)
- Diabetes Screening for Patients on Antipsychotics (SSD)
- Follow Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC)
- Follow Up After Hospitalization for Mental Illness (FUH)
- Follow Up After Emergency Department Visit for Mental Illness (FUM)
- Follow Up After Emergency Department Visit for Substance Use (FUA)
- Glycemic Status Assessment for Patients with Diabetes (GSD)
- Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
- Kidney Health Evaluation for Patients with Diabetes (KED)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
- Osteoporosis Management in Women Who Had a Fracture (OMW)
- Prenatal Immunization Status (PRS-E)
- Prenatal and Postpartum Care (PPC)
- Statin Therapy for Patients with Cardiovascular Disease (SPC)
- Transitions of Care (TRC)
HEDIS hybrid measures
Certain HEDIS hybrid measures require the health plan to conduct medical record review annually. For more information, including a list of the HEDIS hybrid measures, best practices and documentation that should be included in the medical record, and the time frame for annual HEDIS Medical Record Review, please refer to this brief slide deck.
Tips for Star Ratings
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).