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The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.
In 2015 CMS identified 254 quality measures for which providers may choose to submit data. The measures map to U.S. National Quality Standard (NQS) health care quality domains: [4]
It created the Medicare Quality Payment Program. [2] Clinicians can choose to participate in the Quality Payment Program through the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). [3] MIPS is an incentive program that consolidates three incentive programs into one, for eligible physicians.
Over the first three years of the project (2003–2006), participating hospitals raised overall quality by an average of 15.8 percent [3] based on their delivery of 30 nationally standardized and widely accepted care measures [4] [5] to patients in these five clinical areas: acute myocardial infarction (AMI/heart attack) coronary artery bypass ...
The California Medical Assistance Program (Medi-Cal or MediCal) is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level.
Pay for performance systems link compensation to measures of work quality or goals. Current methods of healthcare payment may actually reward less-safe care, since some insurance companies will not pay for new practices to reduce errors, while physicians and hospitals can bill for additional services that are needed when patients are injured by mistakes. [1]
Formal utilization review and quality improvement programs including disease management and case management; An emphasis on preventive care including wellness incentives and patient education; The techniques can be applied to both network-based benefit programs and benefit programs that are not based on a provider network.
HCUP Logo. The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).