Healthcare Effectiveness Data and Information Set (HEDIS)

Patients and families with limited English proficiency (LEP) face disparities in healthcare treatment, resulting in lower-quality care and poorer health outcomes. Disparities in healthcare occur in LEP communities due to language barriers on all sides of interactions. Additionally, race and cultural difference contribute to healthcare disparities. Therefore, healthcare organizations need to provide meaningful services to their LEP members to help decrease health disparities.

One of the ways healthcare organizations can begin to address disparities is by gathering data to help drive decisions. The National Committee for Quality Assurance (NCQA) is helping companies address and close inequities gaps in healthcare. They created the Healthcare Effectiveness Data and Information Set (HEDIS), a set of standardized performance measures that companies can use to identify areas to close gaps in quality. Ultimately, this information can be presented to LEP members so they can compare health plans.

At Avantpage, we help companies bridge worlds through language, understanding, and compassion. One of the ways we do this is to provide language services for companies aiming to improve their HEDIS results. These services include interpretation, translation, accessibility, and more.

For example, it’s been shown that using professional medical interpreters “is associated with decreased health disparities for patients with LEP, improved patient comprehension, fewer medical errors, and greater patient and clinician satisfaction compared to use of ad hoc interpreters, such as family members or bilingual staff.” We can provide companies with this type of interpretation via our OPI and VRI platform, and through comprehensive translation services meeting culturally and linguistically appropriate standards.

Let’s take a deeper look at addressing disparities through HEDIS and how you can work with your language service provider (LSP) to gather data and strategize about improvements.

HEDIS: Addressing Healthcare Disparities

NCQA was created to improve healthcare quality. Their three core ideas to drive work in health equity are:

  1. High quality care is equitable care
  2. No quality without equity
  3. Build equity into all NCQA programs

NCQA created HEDIS as a first step in a multi-year process for sustainable movement to reduce health disparities. HEDIS is an optional standard with 191 million people enrolled in plans that report HEDIS results. The standards include 90 measures of data tracking across the following six domains of healthcare:

  1. Effectiveness of care
  2. Access/availability of care
  3. Experience of care
  4. Utilization and risk adjusted utilization
  5. Health plan descriptive information
  6. Measures reported using electronic clinical data systems

For example, the “effectiveness of care” domain includes measures such as prevention and screening, diabetes, behavioral health, and many more.

For 2022, NCQA updated HEDIS to include race and ethnicity as a portion of the measures to gain additional data about inequities in race and ethnicity in healthcare. For example, Health Net, LLC, gathered data to improve cervical cancer screenings for Chinese members ages 24-64, as the historical data showed that this group experienced lower rates than other groups.

Getting Started with HEDIS

The first step is to collect truthful data to shed light on areas needed for improvement and gain a transparent understanding. From there, you can cross-reference HEDIS to key health areas and identify outcomes for continual improvement. We’d recommend doing the following to learn more about HEDIS.

Buy the HEDIS Standards

You can purchase the HEDIS standards for internal use in your organization. These standards will help guide you in collecting data. By participating, you can improve your healthcare services to better meet your diverse target populations.

Become a Member of the HEDIS Users Group

Become a HEDIS Users Group (HUG) member to get the latest information and engage with other HEDIS members.

Review NCQA’s Reports and Certifications

NCQA generates various reports and research to help you identify ways to improve your healthcare offerings.

Obtain an NCQA Certification

NCQA has various certifications to validate accuracy and support your organization. Read more about how you can obtain one or more certifications.

Partner with Your LSP for Resources and Language Services

Your LSP can collect your data as a step towards meeting HEDIS standards. Your LSP will also have access to a lot of data based on locale, industry, service, and languages. You can use your LSP as a consultant to better understand and leverage that data for strategizing the best efforts to increase quality continuously. You can also leverage the strategy for your language access plans.

For example, a health care provider wanted to understand employee success data for continuous quality improvement. Their goal was to work towards higher equity. We worked with them to create employee assessments as a continuous and proactive measure of language success. Learn how they used the quarterly employee assessments to ensure their staff translators’ improvement, consistency, and quality.

Additionally, here are some other ways to work with your LSP.

Gather Data

Ask your LSP to provide data about your past language services. Use this data to strategize about ways to work towards improvement in equity.

Look at CLAS Standards

Ensure your services and communications meet linguistic and cultural needs by reviewing the Culturally and Linguistically Appropriate Services (CLAS) standards. Your LSP can guide you.

Customize Language Services

Consider customizing language services for added benefits for your organization. Your LSP is like a support system to lean on. For example, when All Plan Letter (APL) passed early in 2021, it required new languages for a variety of healthcare plans. We helped these companies address the new requirements.

Be Prepared

Your LSP can help you navigate your potential needs to prepare you for all language scenarios. For example, have remote interpreting available for last-minute needs so you’re not caught having to use an ad hoc interpreter and risking the quality of the communication. Learn about our secure, on-demand, telehealth interpreting platform.

Use Your Language Services Data

Take data into your own hands. With our new AvantPortal releasing in 2022, you will have access to a dashboard of valuable data that’s also customizable. Data can help you make business decisions and understand how you’re using language services.

Consult with Your LSP for 2022 and Beyond

Consult with your LSP on customized needs to fit your organization. Contact us today to learn how you can optimize your language plans and ask questions.


NCQA established HEDIS to help healthcare organizations close the gap in healthcare inequities. Standards like HEDIS enable LEP healthcare members to review what healthcare companies are doing to improve and experience higher quality care. Your LSP can provide resources, expertise, and language services to help you get started.

To learn more about how we can help you with the HEDIS standards, contact us at [email protected] or (530) 750-2040.