hedis measure
hedis_meas_cdDefinition
ISO-11179 Definition
An individual clinical quality indicator from the Healthcare Effectiveness Data and Information Set maintained by NCQA that measures health plan or provider performance on evidence-based preventive care, chronic disease management, behavioral health, and member experience domains. Each HEDIS measure has a technical specification defining the eligible patient population denominator, the qualifying clinical event numerator, the measurement year, and the data sources acceptable for numerator capture including administrative claims, medical record review, and electronic clinical data. HEDIS measures are used in Medicare Advantage Star Ratings, commercial health plan NCQA accreditation, Medicaid managed care performance reporting, and value based provider contracts.
Healthcare data teams implement HEDIS measure calculation engines using NCQA technical specifications that identify eligible denominators from enrollment and claims data, capture numerator events from claims and supplemental data sources, apply exclusion criteria, calculate measure rates by plan and provider, and produce auditable measure documentation required for NCQA compliance reviews.
Standard Abbreviation
hedis_meas_cd
Category
Production DDL — FACT_QUALITY_MEASURE
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
qlty_key INTEGER NOT NULL -- surrogate key,
mbr_key INTEGER NOT NULL -- FK to DIM_MEMBER,
plan_key INTEGER NOT NULL -- FK to DIM_PLAN,
meas_yr SMALLINT -- measurement year,
hedis_meas_cd VARCHAR(20) -- HEDIS measure code,
denom_ind CHAR(1) -- denominator eligible,
numer_ind CHAR(1) -- numerator met,
excl_ind CHAR(1) -- exclusion indicator,
gap_open_ind CHAR(1) -- care gap open,
star_rtg_nbr DECIMAL(3,1) -- star rating,
qlty_scr DECIMAL(5,2) -- quality score,
perf_thrsh_pct DECIMAL(5,2) -- performance threshold,
raf_scr DECIMAL(10,3) -- risk adjustment factor,
outreach_cnt SMALLINT -- outreach attempts,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →
Why This Term Matters
Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.
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