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 2021 in the following areas:
- Weight Assessment - BMI Percentile, Total (WCC)
- Immunizations for Adolescents - Combo 1 (IMA)
- Immunizations for Adolescents - Combo 2 (IMA)
- Breast Cancer Screening (BCS)
- Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
- Pharmacotherapy Management of COPD Exacerbation - Bronchodilator (PCE)
- Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total (SPC)
- Statin Therapy for Patients with Cardiovascular Disease - Adherence - Total (SPC)
- Comprehensive Diabetes Care - HbA1c Screening (CDC)
- Comprehensive Diabetes Care - HbA1C (poor) Control (>9%) (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 Statin Therapy (SPD)
- Statin Therapy for Patients with Diabetes - Statin Adherence - 80% (SPD)
- Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
- Use of Opioids from Multiple Providers - Multiple Pharmacies (UOP)
- Adults' Access to Preventive/Ambulatory Services - Ages 20-44 (AAP)
- Adults' Access to Preventive/Ambulatory Services - Ages 45-64 (AAP)
Proposed Focus for HEDIS 2021-2022:MedStar Family Choice targets areas we can be improved or where improvement can be kept and grown more:
- Wellness, Immunizations, and PCP Visits for Adults and Children
- Prenatal and Postpartum Care
- Diabetes Care (A1C Screening, A1C Control, and Dilated Eye Exam)
- Mammograms, Pap Testing, and Chlamydia Testing
- Medications for Asthma, Diabetes, 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: