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Healthcare Effectiveness Data and Information Set (HEDIS®)

HEDIS® 2017

Calendar Year 2016 Data

Completing an NCQA HEDIS Compliance Audit™ has been required of managed care organizations (MCOs) operating in Maryland since 2001. Under the HealthChoice regulations, the MCOs report designated subsets of the Medicaid HEDIS measures. MedStar Family Choice benchmarks its performance against the Maryland Medicaid plans and the NCQA Means and Percentiles Report. NCQA accredits and certifies a wide range of healthcare organizations and manages the evolution of HEDIS.

The Department of Health and Mental Hygiene (DHMH) and NCQA require plans to submit all measures required for Medicaid plans in order to retain NCQA accreditation, and NCQA also requires reporting of measures for their Rating of Health Plans.

We are happy to report MedStar Family Choice scored above or met the Maryland average for HEDIS 2017 in the following areas:

Scores Above the Maryland Average for HEDIS 2017, Calendar Year 2016

  • Childhood Immunization Status - Combo 3 (CIS)
  • Lead Screening in Children (LSC)
  • Appropriate Testing for Children With Pharyngitis (CWP)
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
  • Pharmacotherapy Management of COPD Exacerbation - Systemic, Corticosteroid and Bronchodilator (PCE)
  • Asthma Medication Ratio - Total (AMR)
  • Controlling High Blood Pressure (CBP)
  • Statin Therapy for Patients With Cardiovascular Disease (SPC)
  • Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
  • Comprehensive Diabetes Care - HbA1C Screening (CDC)
  • Comprehensive Diabetes Care - HbA1C (poor) Control (Less than 9 percent) (Lower is better) (CDC)
  • Comprehensive Diabetes Care - HbA1C Control (Less than 8 percent) (CDC)
  • Comprehensive Diabetes Care - Blood Pressure Control (Less than 140/90) (CDC)
  • Comprehensive Diabetes Care - Nephropathy Screening or Treatment (CDC)
  • Disease-Modifying Anti-Rheumatic Drug Therapy (ART)
  • Annual Monitoring for Patients on Persistent Medications - Diuretics (MPM)
  • Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
  • Appropriate Treatment for Children With Upper Respiratory Infection (URI)
  • Frequency of Ongoing Prenatal Care - Greater Than or Equal to 81 percent (FPC)
  • Well-Child Visits in the First 15 Months of Life - Five or Six Visits (W15)

MedStar Family Choice continues to score high compared to the Maryland Medicaid average for many measures. MedStar Family Choice would like to thank you for your cooperation and assistance in getting our members into care.

Proposed Focus for HEDIS 2018

Areas targeted for the next HEDIS cycles 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
  • Asthma Medications

As we continue to improve and strive for high scores, your dedication to quality health care is very much appreciated.

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

Information current as of: 12/14/17