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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 many 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 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 in order 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 2017 in the following areas:

Scores above the Maryland Average for HEDIS 2017

  • 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 - A1C (poor) Control
  • A1C Control
  • Blood Pressure Control and 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 - >= 81% (FPC)
  • Well-Child Visits in the First 15 Months of Life - 5 or 6 Visits (W15)

Proposed Focus for HEDIS 2018:

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

  • 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

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 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.

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 will continue to get 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: 12/14/17