What type of data does HEDIS typically rely on for its measures?

• A. Survey data only
• B. Claims data and clinical data
• C. Qualitative data from interviews
• D. General public feedback on healthcare services

Answer: (B)

HEDIS, or the Healthcare Effectiveness Data and Information Set, primarily utilizes claims data and clinical data for its measures. Claims data includes information collected when a healthcare service is billed, such as diagnoses, treatments, and patient demographics, which is crucial for measuring care provided to populations over a defined period. This quantitative data helps assess the efficiency and effectiveness of healthcare services.

Clinical data complements claims data by providing detailed clinical information directly from health records, which may include lab results, medication prescriptions, and follow-up care details. Together, these types of data allow for a comprehensive evaluation of healthcare quality measures, including patient outcomes, preventive measures, and adherence to clinical guidelines, which are essential for calculating HEDIS scores.

The other types of data mentioned, such as survey data, qualitative data from interviews, and general public feedback, while useful in certain contexts, do not align with the core focus of HEDIS measures. HEDIS requires standardized and quantifiable data to ensure comparability and accuracy in assessing healthcare performance across different health plans.