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Healthcare Effectiveness Data and Information Set (HEDIS®)

Healthcare Effectiveness Data and Information Set (HEDIS®)

The National Committee on Quality Assurance (NCQA) is a national not-for-profit company that maintains quality data on health plans from across the country. NCQA has specific quality measures that they ask each health plan to report on yearly. The quality measures are rolled up in a tool called HEDIS. This lets everyone see how health plans compare to each other in many different areas of healthcare. HEDIS evaluates measures in the areas of preventive care (adults and children), immunizations of children and teens, care of pregnant women, and the care of chronic diseases like asthma and diabetes. The results are audited and reported to NCQA.

MedStar Family Choice reported all measures required for Medicaid plans in order to retain NCQA accreditation, as well as any additional measures required by the Maryland Department of Health.

We are happy to report that MedStar Family Choice scored above or met the Maryland Average for HEDIS 2016 in the following areas:

Scores above the Maryland Average for Calendar Year 2016

  • Adult BMI Assessment (ABA)
  • WCC - Counseling for Nutrition - Total (WCC)
  • Childhood Immunization Status - Combo 3 (CIS)
  • Lead Screening in Children (LSC)
  • Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
  • Appropriate Testing for Children With Pharyngitis (CWP)
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
  • Asthma Medication Ratio - Total (AMR)
  • Controlling High Blood Pressure (CBP)
  • Comprehensive Diabetes Care - HbA1C (poor) Control (>9%) (lower is better) (CDC)
  • Comprehensive Diabetes Care - HbA1C Control (<8%) (CDC)
  • Comprehensive Diabetes Care - Blood Pressure Control (<140/90) (CDC)
  • Disease-Modifying Anti-Rheumatic Drug Therapy (ART)
  • Children's Access to Primary Care Practitioners - 12-24 Months (CAP)
  • Prenatal and Postpartum Care - Prenatal Timeliness (PPC)
  • Frequency of Ongoing Prenatal Care - < 21% (FPC)
  • Frequency of Ongoing Prenatal Care - >= 81% (FPC)
  • Well-Child Visits in the First 15 Months of Life - 5 or 6 Visits (W15)
  • Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34)

Proposed Focus for HEDIS 2017:

Areas targeted for the next HEDIS cycle are those areas where MedStar Family Choice feels its performance can be improved or where improvement can be sustained and increased:

  • Well-Child Visits
  • Childhood and Adolescent Immunizations
  • Prenatal and Postpartum Care
  • Diabetes Testing (A1C Screening and Dilated Eye Exam)
  • Pap and Chlamydia Testing
  • Controlling High Blood Pressure
  • Weight Assessment and Counseling for Nutrition and Physical Activity

Over the next year, our members will be hearing from us on these issues. All members should see their doctor annually. In the first years of life, babies need to see their doctor much more frequently. You will receive mailings and phone calls reminding you to schedule your necessary appointments.

Women need to make sure they get their pap tests and mammograms as needed for their age. Check with your doctor to see when you need testing.

All children and teens should see their doctor every year. While shots are not always needed at the visit, it is important that your doctor sees your child regularly so that he/she can ensure that your child is growing appropriately. Women who have just delivered a baby will be called by MedStar Family Choice to help them schedule a check-up with their OB to make sure that they have healed from pregnancy.

It is important for women to get routine pap smears. In addition, mammograms are important to receive once you turn 40. Members with a history of breast cancer may need to receive one sooner. It is very important that you speak to your doctor about these tests. You will receive reminders from MedStar Family Choice too.

Our members with diabetes will continue to receive helpful diet tips and reminders about the tests they need to receive to make sure their blood sugar levels are in control.

Our members with asthma will continue to receive tips and reminders about how to handle their symptoms and the need to take medicines as their doctor orders.

If you ever need help scheduling an appointment, our Outreach Department is here to help you. Please call us Monday through Friday 8:30 a.m. - 5:00 p.m. at 800-905-1722.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

Information current as of: 07/25/17