Today, more than 200 million people are enrolled in health plans that report HEDIS results covering areas like prevention and screening, respiratory health, cardiovascular health, diabetes, musculoskeletal conditions, mental health and medication management.1 There’s no doubt that a large portion of the population is represented in those categories, but what about the people who aren’t?
The Centers for Disease Control and Prevention estimates that 6 in 10 Americans have a chronic condition, and 4 in 10 have more than one.2 HEDIS doesn’t measure the efficacy of health care for all of them. For example, it’s estimated that about 25% of adults in the U.S have non-alcoholic fatty liver disease (NAFLD),3 around 37 million adults have chronic kidney disease4 and 50 million have one or more autoimmune disease.5 Though HEDIS may have metrics that address other facets of their health care, like preventive care, it doesn’t have metrics designed to evaluate the quality of the health care for these important conditions.
For almost 25 years, ActiveHealth has been committed to the idea that putting data-driven insights into the hands of members and providers can positively impact health outcomes. We built our proprietary CareEngine® technology specifically for the purpose of gathering vast amounts of health data and comparing it against evidence-based, independently validated clinical rules. Now, we have thousands of clinical rules covering more than 200 conditions, including the prevalent and costly conditions covered by HEDIS measures, as well as conditions like kidney disease, NAFLD, lupus and sickle cell disease. These conditions may be less prevalent in the general population, but are no less devastating to people living with them.
HEDIS was conceived to provide a standardized metric of health care efficacy, and it does so admirably. But when we’re asked “Aren’t HEDIS metrics enough?” The answer is unequivocally no, they’re not. Having the clinical depth and breadth to include people already covered by HEDIS and to also look beyond the generally accepted metrics allows us to find care gaps that can be easily missed. We can identify opportunities for people to improve their individual health, intervene in meaningful ways and positively impact their lives and the lives of those who love them.
1 https://www.ncqa.org/hedis/
2 https://www.cdc.gov/chronicdisease/about/index.htm
3 https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep4.1935
4 https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html
5 https://autoimmune.org/wp-content/uploads/2019/12/1-in-5-Brochure.pdf
Services are provided by ActiveHealth Management, Inc. Our programs, care team and care managers do not provide diagnostic or direct treatment services. We assist you in getting the care you need, and our program is not a substitute for the medical treatment and/or instructions provided by your health care providers. The CareEngine® is a proprietary technology platform developed by ActiveHealth Management, Inc. In conjunction with clinicians, the CareEngine continuously analyzes claims and other data against evidence-based best practices and alerts the members and their physicians about possible care gaps and other inconsistencies. Information is not a substitute for diagnosis or treatment by a health care professional.
