Improve both hedis and cahps performance as described below quality performance data hedis and customer satisfaction results cahps amerihealth caritas district of columbia has determined an opportunity for improvement for any hedis or cahps score at. Hedis is a group of more than 90 datacentric measures for clinical and evidencebased care. Table 2list of cy 2016 performance measures for amerigroup community care. Qualityinitiativesgeninfo downloads 2016 qrs measure technicalspecifications.
The following hedis 2016 firstyear status measure will be publicly reported for hedis 2017. Hsag will use these results in addition to the measures hsag validated as data. You should refer to this document to familiarize yourself with current hedis. The information provided is in this document is for 2016 hedis period and is current at the time this document was created. Postpartum care for inclusion in the aligned measure set. All surveys must be conducted according to ncqa protocols described in hedis 2016, volume 3. Indicator measure baseline year 2016 dekalb medical physicians group diabetic patients a1c levels less than 9.
Will be part of health plan accreditationas cahps has been for years. An added age criteria must be applied to determine if the correct format was used for the patients age at the time of the visit. Healthplansmedicareadvtgspecratestatsdownloadsadvance2016. Illinois quality withhold measure technical notes hhs. Hedis measures provider matrix august 2017 hedis measures are used to gauge the quality of care health plan members are receiving. Slideshare 7 strategies to improve hedis scores and star ratings 2. Healthcare effectiveness data and information set hedis. The tables below explain the national committee for quality assurance ncqa healthcare effectiveness data and information set hedis measures for two types of care.
The dhs extensively uses hedis measures for its p4p initiative. Hedis gic measure documentation to submit for a pass documentation to submit for exclusion from measure col colorectal cancer screening members age 50 75 the record must indicate the name of the test and date the screening was performed. Hedis healthcare effectiveness data and information set is a set of standardized performance measures developed by the national committee for quality assurance ncqa to objectively measure, report, and compare quality across health plans. For information on medications covered by mvp see the mvp drug formulary available by visiting. Specifications for survey measures, and administered by a vendor that is ncqacertified. The healthcare effectiveness data and information set hedis measures, which were developed by the national committee for quality assurance ncqa, are a key tool in evaluating the quality of patient care and are used by more than 90% of healthcare plans and by many leading employers and regulators in the united states. Ncqa hedis program requirements, applicable laws, and l.
Hedis measures performance in health care where improvements. In addition to the ahrq and the cms adult and child core set measures audited by hsag, dch required wellcare to report a selected set of hedis measures to dch. This value set directory vsd includes value sets and codes needed to calculate and report hedis measures included in the 2016 quality rating system qrs. This easytouse hedis ataglance guide gives you the tools to meet, document and code hedis measures. Measuring adherence with antidepressant medication. Peach state health plan georgia department of community health.
Hedis measures are developed by the national committee for quality assurance ncqa, which is a private. Cares policy change from time to time, and information and. To do well on hedis, measure a patients weight and calculate their body mass index bmi during an outpatient office visit at least once every two years and report it on a claim. Healthcare effectiveness data and information set wikipedia. Monahrq v 7 release notes home agency for healthcare. Six or more wellchild visits wellcare value set on different dates of service on or before the 15month birthday. In accordance with the 2016 final rule as set forth in 42 cfr 438. Measurement year 2016 18 as of 112015 74 as of 1231 2016 note. Improve both hedis and cahps performance as described below quality performance data hedis and customer satisfaction results cahps amerihealth caritas district of columbia has determined an opportunity for improvement for any hedis or cahps score at or below the 75th percentile national benchmark. Download center and will be updated on october 1, 2015. Appendix d displays the final audited hedis 2016 results for all required measures, covering the cy 2015 measurement period. Diabetes medication table the medication list below is used when evaluating the smd measure criteria. Need for comprehensive health care quality measures for older.
Use of appropriate medications for people with asthma asm. The cmo reported this measure using the hedis 2016, volume 2. Integrated care workgroup new york state department of. Wellcare values everything you do to deliver quality healthcare for our members your patients. Improving documentation of electronic health records through. Feb 08, 2016 ability to add new or non hedis measures february 8, 2016 predecisional proprietary and confidential 12 1 a period of 12 consecutive months determined on a rolling basis with a new 12month period beginning on the first day of each. Hedis reporting is required for ncqa accreditation, cms medicare. Overview of the hedis measurement set and how the data are used. This code was retired and replaced with cpt code 81528 on jan. Factors associated with adherence to the hedis quality. It recommended considering prenatal and postpartum care. See hedis 2018 technical specifications for health plans volume 2 for details. This matrix provides measure specific information for needed services and directions on how to close gaps in the care of your members.
The 2016 hedis measures for qrs contained in this document are ed by ncqa and. Healthplansmedicareadvtgspecratestats downloads advance2016. Pinc is the first company to receive ncqas new electronic clinical quality measures ecqm certification. Specifications that is referenced in the hedis reporting requirements hpms. These measures determine whether members access preventive or routine care, are managing their illness well, or are taking medication as prescribed. Hedis measure evaluation criteria consistent with comprehensive national definition of access, safety, and quality consistent with measures used by leading health systems hedis measures data in mhs purchased care data is based on claims data. Hedis is a tool used by more than 90 percent of americas health plans to measure performance on important. Hedis measures do not account for many important aspects of health care quality. Measures collected through the medicare health outcomes survey. Appendix d displays the final audited hedis 2019 results for all required measures, covering the cy 2018 measurement period.
The term hedis originated in the late 1980s as the product of. Depression is a significant problem for the managed care system. Hedis 2016, volume 6 hedis 2016 the healthcare effectiveness data and information set hedis is the most widely used set of health care performance measures in the united states. In addition, nqf dropped endorsement of the measure. Hedis star scores compared to physicians in other types of agreements. The healthcare effectiveness data and information set hedis is a widely used set of performance measures in the managed care industry, developed and maintained by the national committee for quality assurance ncqa hedis was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. Premera blue cross network news blue shield of alaska. Ratings, is focused on the impact of that hedis measure for medicare advantage. See attached instructions for obtaining 2016 quality rating system qrs hedis value set directory.
This can include visit notes, procedure notes or pathology reports that indicate the. Hedis he dis healthcare effectiveness data and information set 4. Overarching principles and definitions active patients. Final audited hedis measure results from ncqas interactive data submission system idss were submitted to hsag and provided to dch. Information related to all 2020 hedis measures has been extracted from the ncqa 2020 hedis technical specifications volume 2. Indicator measure baseline year 2016 increasing number of patientsconsults in the outpatient diabetes program. May 04, 2016 7 strategies to improve hedis scores and star ratings 1. Physicians in humana ma feeforservice agreements performed better on hedis star measures in 2017 versus 2016. The measurement period was identified by dch as cy 2018 for all measures table 2 lists the performance measures that hsag validated, the method required by dch for data collection, and the specifications the cmo was required to use for each of the measures. Listed codes are examples acceptable for hedis 820 weight assessment for childrenadolescents. Two or more wellchild visits on different dates of service between the childs 15month birthday plus 1 day and the 30month birthday. It also includes general guidelines for data collection and reporting, detailed instructions on how to perform the necessary calculations and guidelines for sampling. Hedis healthcare effectiveness data and information set is a set of performance measures.
Technical specifications for health plans, but applied to its medicaid population. This measure was considered by the taskforce on 121817, but not endorsed since masshealth was no longer using the measure and due to high performance. Downloads 2016 qrs measure technicalspecifications. See attached instructions for obtaining 2017 quality. Download the new mqic app on your mobile device today. These can be used to compare the performance of medicaid health plans. The icd10 codes that need to be included all start with z68 and end with the bmi percentage for bmis from 2039. Validation of performance measures georgia department of. Hedis 2016 patient level data file submission instructions 2015 measurement year version 2.
A subset of hedis measures will be collected and reported for the marketplace health care exchanges product lines. Ncqa develops hedis measures through a committee represented by purchasers, consumers, health plans. Evidence based recommendations supported by nqf, ncqa, pqa. Hedis measures are reported as administrative or hybrid. Please refer to for hedis program measures and guidelines as well as relevant statutes. Hedis measures reference value sets are available for download at store. Antidepressant medication helps ameliorate the symptoms of depression yet adherence to medication is known to be poor. Measures collected using electronic clinical data systems 3 ncqa collects hedis data from health plans and other healthcare organizations performance in these measures may be incorporated into payforperformance contracts of the 90 measures, 8 relate to behavioral health. The 2016 chna and this implementation plan is available for download and can be accessed at.
Generally, hedis measures assess performance in specific aspects of care. If your office uses manual blood pressure cuffs, dont. A required resource for anyone involved in collecting, calculating or submitting hedis data, volume 2 features the complete technical specifications for each measure. Even though a lot of focus is placed on valuebased care in this report, it is important to note. Pdf national healthcare policy is affecting the way health systems provide care by mandating accountability through. All plans must generate the sample frame according to ncqa specifications. In recent years, achieving high scores on hedis measures and medicare star ratings has taken on greater importance for health plans.
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