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 many 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 different areas of healthcare. HEDIS has measures for preventive care (adults and children), immunizations of children and teens, care of pregnant women, and the care of diseases like asthma and diabetes. The results are audited and reported to NCQA.

MedStar Family Choice reported all measures required for Medicaid plans to get NCQA accreditation and any extra 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 2020 on 2019 rates in the following areas:

  • Adult BMI Assessment (ABA)
  • WCC - Weight Assessment - BMI Percentile - Total (WCC)
  • WCC - Counseling for Nutrition - Total (WCC)
  • WCC - Counseling for Physical Activity - Total (WCC)
  • Childhood Immunization Status - Combos 2, 3, 4, 5, 6, 7, 9, and 10 (CIS)
  • Immunizations for Adolescents - Combos 1 and 2 (IMA)
  • Lead Screening in Children (LSC)
  • Breast Cancer Screening (BCS)
  • Cervical Cancer Screening (CCS)
  • Appropriate Testing for Children With Pharyngitis (CWP)
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
  • Pharmacotherapy Management of COPD Exacerbation - Bronchodilator (PCE)
  • Medication Management for People with Asthma (MMA)
  • Statin Therapy for Patients with Cardiovascular Disease - Adherence (SPC)
  • Comprehensive Diabetes Care - HbA1c Screening (CDC)
  • Comprehensive Diabetes Care - HbA1C (poor) Control (>9%) (lower is better) (CDC)
  • Comprehensive Diabetes Care - HbA1C Control (<8%) (CDC)
  • Comprehensive Diabetes Care - Eye Exams (CDC)
  • Comprehensive Diabetes Care - Blood Pressure Control (<140/90) (CDC)
  • Statin Therapy for Patients with Diabetes - Received (SPD)
  • Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
  • Risk of Continued Opioid Use - >=31 Days - Total (COU)
  • Adults' Access to Preventive/Ambulatory Services - Ages 20-44 (AAP)
  • Adults' Access to Preventive/Ambulatory Services - Ages 45-64 (AAP)
  • Children's Access to Primary Care Practitioners - 12-24 Months (CAP)
  • Children's Access to Primary Care Practitioners - 25 Months - 6 Years (CAP)
  • Children's Access to Primary Care Practitioners - 7-11 Years (CAP)
  • Children's Access to Primary Care Practitioners - 12-19 Years (CAP)
  • Prenatal and Postpartum Care - Postpartum Care (PPC)
  • Well-Child Visits in the First 15 Months of Life - 0 Visits (W15)

Proposed Focus for HEDIS MY 2020:

MedStar Family Choice targets areas we can be improved or where improvement can be kept and grown more:

  • Wellness and PCP Visits for Adults and Children
  • Childhood and Adolescent Immunizations
  • Prenatal and Postpartum Care
  • Diabetes Care (A1C Screening, A1C Control, and Dilated Eye Exam)
  • Mammograms, Pap Testing, and Chlamydia Testing
  • Controlling High Blood Pressure
  • Medications for Asthma and Cholesterol

Over the next year, our members will be hearing from us on these issues. All members should see their doctor every year. 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 needed 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 to make sure 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.

Our members with diabetes will continue to get 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 and other conditions will continue to get tips and reminders about how to handle their symptoms and the need to take medicines as their doctor orders. We have a mail-order pharmacy and you can get many medications delivered to you. Many medications can also be filled 90 days at a time.

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: 12/14/20