Quality Measure Performance Across Insurance Types
Turning Data into Insight, and Insight into Action®
Quality measures hold providers and healthcare payers (private insurance companies as well as the Medicare program) accountable for delivering efficient, evidence-based, high-quality, and cost-effective care. The Healthcare Effectiveness Data and Information Set (HEDIS®) is a set of performance measures used widely in managed care for quality improvement. The National Committee for Quality Assurance (NCQA) develops and maintains the measures. HEDIS is designed to compare health plan performance relative to national benchmarks.
Annually, Inovalon evaluates how different types of insurance plans perform on a set of 5 quality measures using claims data from commercial, Medicare, and Medicaid insurance health plans. These measures assess a range of service and outcome-based issues that are important to achieving high-quality healthcare, including access to care, use of preventive screenings and tests, use of evidence-based treatments, and hospital readmissions.