Since 1994, many of California’s major health plans have collaborated with employers, physicians, and other health care providers to gather standardized health plan performance data as part of the California Cooperative Healthcare Reporting Initiative (CCHRI).

CCHRI promotes collaboration instead of competition in data collection and reporting, ensuring that consumers have the uniform information they need to compare the performance of health plans. CCHRI also makes efforts to streamline the data collection process, reducing the administrative burden on physicians, health plans, and other CCHRI participants.

The 2007 HEDIS (Health Plan Employer Data and Information Set) data collection began this month. Individual physician data requests began in mid-January. Medical group data requests will begin in mid-February. Physicians who receive requests for patient records are encouraged to respond as soon as possible to avoid multiple follow-up requests for the same records.

Physicians should be aware that HEDIS data collection is permitted under the HIPAA privacy rule. HEDIS data collection continues to be governed by the Confidentiality of Medical Information Act (CMIA). This act authorizes disclosure of records to health plans and their agents without express patient consent for the purpose of measuring the level and quality of care. Please note that special rules still apply to records involving inpatient or outpatient psychotherapy, HIV test results, substance abuse, or developmental disabilities. For more information, see CMA ON-CALL document #1110, “Access by Third Parties to Sensitive Information.”

ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.

Health plans will reimburse physicians for HEDIS data submissions. The level of reimbursement varies depending on the physicians’ health plan contracts.

Click here for measure-specific instructions and tips for physicians collecting HEDIS data.

Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.