Case Study

While the United States has the most expensive health care system, it is fairly inaccessible and the quality of care falls short when compared to many healthcare systems in the world. Statistics obtained from The World Bank’s 2013 database show that the U.S. has the highest health care costs of any industrialized nation. In a report released by The Common Wealth the U.S. consistently underperformed relative to other industrialized countries on most dimensions of performance indicators (Davis, Stremikis, Squires, & Schoen, 2014). This report ranked the overall U.S. health care system last amongst the 11 countries surveyed. High costs and relatively low quality has become a major cause for concern. Several programs have been put in place in an effort to cut down on costs, while improving the quality of care delivered. Examples of such programs are Healthcare Data Information Set (HEDIS), HMOs, and most recent the Patient Protection and Affordable Care Act (PPACA). HEDIS is an accreditation program that was initiated in 1991 as a centralized database for employers to assess the quality of Insurance and Healthcare providers nationwide. HEDIS forth strict regulations and benchmarks that must be met and maintained in order to be HEDIS accredited. HEDIS measures are divided into eight domains: effectiveness of care, access of care, satisfaction with care experience, health plan stability, use of service, cost of care, and informed healthcare choices. These measures collect data based on specific medical conditions. The particular conditions traced include but are not limited too: controlling high blood pressure, comprehensive diabetes care, and breast cancer (Schultz, 2011). This research paper takes an in depth look at HEDIS, its costs, and whether or not the savings achieved through improved quality of care after applying HEDIS surpass the cost of its implementation. The data researched in this paper focuses on the quality measures provided for the care of Diabetes;