HEDIS In Healthcare

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The root cause for the change in health care is due to the rising cost and the need to promote quality health care and enhance preventable measures for chronic disease management. Health care spending grew 3.7 percent in 2012 and the traditional way medicine was practiced had to change (Edlin, Goldman & Leive, 2014). During the 1900s powerful influences of clinical treatment information, skepticism of the medical community’s ability to ensure high-quality health care based on the science of quality measures along with cost resulted in medicine transcending from anecdotal, non-evidence based to one lead by good data that enhanced the discovery of improved treatment practices, coupled with the public’s interest and investment in modern medicine …show more content…
To identify the linkage between quality health and services provided against improved health care, HEDIS utilizes the administrative data central to quality improved with health care quality measures and treatment identification strategies based on diagnosis, treatment and procedure codes and determines the validity of the data (Harris, Reeder, Ellerbe & Bowe, 2011). The positive outcome of quality measures like HEDIS is that it improves the health status of patients, decrease morbidity and saves money. In addition, these quality measures have been developed around health care interventions where there is sound scientific evidence of effectiveness (Williams & Torrens, 2008). The rapid aging population and the greater longevity of people with chronic conditions will require organizations to coordinate care in order for them to deal with this challenge, health policy and professionals are pushing disease management programs (i.e. integrated care, shared care, care management) to enhance quality and continuity of care for the chronically ill (Pay-for-performance in disease…literature, n.d., 2011). In 2005, these HEDIS measures targeted a study of 3.3 million and …show more content…
Despite the benefits of enhanced quality measures there is are disparities on compliance. The barriers to the plan designs are often the cost of education (physician, health workforce and patients), increasing deductibles, patient adherence, and dissemination of quality information (Custer, 2014). Therefore, despite a physician assessment and adherence for preventable medicine patients sometimes fail to comply. Plan design can affect patient adherence in ways of increase quality scores and plan enrollment, consumer-directed plans with high deductibles sometimes offer low or no cost for preventable medicine, however most enrollees in these plans do not understand the feature and therefore avoid preventative care because think they will bear the cost (Custer, 2014). Furthermore according to a survey conducted in 2006 of 13 Pennsylvania commercial insurers plans less than 57 percent (less than optimal) enrollees did not obtain a colorectal cancer screening to rule out the nation’s second leading cause of death, due to deficiencies in insurance coverage (Sarfaty & Myers, 2008). However, this is changing with the push for increased quality metrics in medicine. For example, chronic diseases effects older adults more than any other age group and older Americans are heavy users of prescription medication, however medication non-adherence in older Americans is a serious public health problem that impacts the health of this

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