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Healthcare Effectiveness Data and Information Set (HEDIS®)

HEDIS® 2016

Calendar Year 2015

Completing a NCQA HEDIS Compliance Audit™ has been required of Managed Care Organizations operating in Maryland since 2001. Under the HealthChoice regulations, the Managed Care Organizations 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 health care organizations and manages the evolution of HEDIS, the performance measurement tool used by health plans nationwide.

MedStar Family Choice reported all measures required for Medicaid plans in order to retain NCQA accreditation, as well as any additional measures required by 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 HEDIS 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)

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

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

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: 07/25/17