03/02/2026
Understanding HEDIS: The Measures Behind Quality Care
At FDGMSO, quality performance is guided by HEDIS (Healthcare Effectiveness Data and Information Set) — a standardized system used nationwide to evaluate the care patients receive under Medicare Advantage.
HEDIS measures focus on key areas that drive better health outcomes:
1. Preventive Care
• Annual Wellness Visits
• Breast, Colorectal, and Cervical Cancer Screenings
• Adult Immunizations (Flu, Pneumonia, Shingles)
• Osteoporosis screening
• Depression screening and follow-up
2. Chronic Disease Management
• Diabetes control (A1c testing and control, eye exams, kidney monitoring)
• Blood Pressure control (Hypertension)
• Cholesterol management (Statin therapy)
• COPD and Asthma management
3. Medication Adherence
• Diabetes medications
• Blood pressure medications
• Cholesterol (statins)
4. Care Coordination & Patient Safety
• Follow-up after hospital or ER visits
• Medication reconciliation after discharge
• Transitions of care management
5. Patient Experience & Access
• Timely appointments and access to care
• Communication with providers
• Overall patient satisfaction (CAHPS)
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Why HEDIS matters
Strong HEDIS performance leads to higher Medicare Star Ratings, which reflect:
✔ Better patient outcomes
✔ Strong preventive care
✔ Improved chronic condition control
✔ Enhanced patient experience
At FDGMSO, we support providers with data, care gap identification, and population health strategies to ensure high-quality, value-based care.
Quality is not just measured — it’s managed.
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