Healthcare Effectiveness Data and Information Set (HEDIS®)

HEDIS® 2019

Calendar Year 2018 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 Maryland Department of Health and NCQA require plans to submit all measures required for Medicaid plans  to retain NCQA accreditation and other measures at it’s the department’s discretion.

We are happy to report MedStar Family Choice scored above or met the Maryland average for HEDIS 2019 in the following areas:

Scores Above the Maryland Average for HEDIS 2019, Calendar Year 2018

  • 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 - Combo 2 (CIS)
  • Childhood Immunization Status - Combo 3 (CIS)
  • Immunizations for Adolescents - Combo 1 (IMA)
  • 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 (PCE)
  • Pharmacotherapy Management of COPD Exacerbation - Bronchodilator (PCE)
  • 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 - Nephropathy Monitoring (CDC)
  • Comprehensive Diabetes Care - Blood Pressure Control (<140/90) (CDC)
  • Disease-Modifying Anti-Rheumatic Drug Therapy (ART)
  • Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
  • Annual Monitoring for Patients on Persistent Medications - ACE/ARBs (MPM)
  • Annual Monitoring for Patients on Persistent Medications - Diuretics (MPM)
  • Annual Monitoring for Patients on Persistent Medications - Total (MPM)
  • Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
  • Risk of Continued Opioid Use - >=15 Days - Total (COU)
  • 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)
  • Prenatal and Postpartum Care - Postpartum Care (PPC)
  • Well-Child Visits in the First 15 Months of Life - 0 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.

To further improve we will be coordinating with your offices by providing gaps in care reports and helping to identify members who need care. We have many resources to address transportation, scheduling, and other barriers for your members. We also offer mail-order pharmacy and 90-day prescriptions for most chronic medications. Please call us Monday through Friday 8:30 a.m. - 5:00 p.m. at 800-905-1722 for more information.

Proposed Focus for HEDIS 2019

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:

  • 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

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: 10/28/19