Why are the denominators in the HEDIS® metric and the Action List different?
The purpose of the HEDIS® metrics is to be able to have standardized, nationally-recognized metrics which healthcare organizations can measure and compare their clinical performance. The HEDIS® methodologies are restrictive and prescriptive; they strictly define how to calculate numerators and denominators for their metrics and often specify continuous enrollment, age and other constraints. This ensures uniformity and comparability of populations and ensures that healthcare facilities have equal opportunities for excellence in the provision of healthcare. Because continuity of care is an important consideration when measuring and comparing the appropriateness of care over time, the HEDIS® methodologies are all based on continuous enrollment criteria. The MTF is not benchmarked on individuals who are not enrolled in TRICARE Prime at their facility or who do not meet specific continuous enrollment criteria. Therefore, in order to be eligible for inclusion in the HEDIS® population, eligib
