TO: FROM: DATE: RE: Mid-Year Updates Note: NCQA Benchmarks & Thresholds 2014

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1 TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Policy DATE: July 25, 2014 RE: 2014 Accreditation Benchmarks and Thresholds Mid-Year Update This document reports national benchmarks and national and regional thresholds for HEDIS 1 measures and HEDIS/CAHPS 2 5.0H survey results and will be used to score health plans for accreditation year Each measure table is noted as updated from 2013 or no change from Refer to each measure for relevant footnotes and information about region combining. In addition, the Adjusted Accreditation Points for Medicaid Plans by Region section has been updated. NCQA allows Medicaid product lines to be scored on the CAHPS Health Plan Survey 5.0H Adult Version, on the Child Version or on the Children With Chronic Conditions Survey questions/composites. General population results are used to calculate both the Child and the Children With Chronic Conditions surveys; all organizations (including those whose accreditation score is based on a previous standards year) may submit either version. Mid-Year Updates Updated the benchmarks and thresholds for the following measures: Antidepressant Medication Management Effective Acute Phase Treatment (all product lines) Antidepressant Medication Management Effective Continuation Phase Treatment (all product lines) Breast Cancer Screening (all product lines) Flu Vaccinations for Adults Ages (commercial) Use of Appropriate Medications for People With Asthma (commercial) Use of Appropriate Medications for People With Asthma (Medicaid) Use of High-Risk Medications in the Elderly Rate 2 (Medicare) Updated the Medicaid Adjustment points for applicable measures. Note: Italicized measures in this section indicate added measures or a change in adjustment points from the initial 2014 Benchmarks and Thresholds memo. 1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 2 CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

2 2 Changes from the 2013 memo: The Cervical Cancer Screening measure will be scored NA for the commercial and Medicaid product lines for accreditation year 2014, regardless of the year when the health plan was accredited. Special scoring rules that were added or revised are noted. Retired Measures The following measures were retired from accreditation 2013 scoring and will not be scored for organizations accredited on the 2013 or 2014 standards. However, organizations accredited on the 2012 standards or earlier will be scored using the organization s submitted rate for these measures. Prenatal and Postpartum Care Timeliness of Prenatal Care Rate (commercial). Note: Only the Postpartum Care Rate in the Prenatal and Postpartum Care measure will be scored for the commercial product line for organizations accredited on the 2013 or 2014 standards. Both rates will be scored for organizations accredited on the 2012 standards or earlier. The Timeliness of Prenatal Care and Postpartum Care rates will be scored for the Medicaid product line for all accreditation standards years. Use of Appropriate Medications for People With Asthma (commercial). Annual Monitoring for Patients on Persistent Medications (Medicare). Use of High-Risk Medications in the Elderly Rate 2 (Medicare). Note: Only Rate 1 in the Use of High-Risk Medications in the Elderly measure will be scored for organizations accredited on the 2013 or 2014 standards. Both rates will be scored for organizations accredited on the 2012 standards or earlier. Accreditation 2014 Scoring As described in the Standards and Guidelines for the Accreditation of Health Plans, NCQA requires organizations to submit specified HEDIS measures and CAHPS 5.0H survey results annually. NCQA determines the HEDIS measure portion of the score by comparing organization results with a national benchmark (the 90th percentile of national results) and with regional and national thresholds (the 75th, 50th and 25th percentiles). NCQA uses the higher of two scores: the result based on comparison with the average of the regional and national thresholds, or the result based on comparison with national thresholds. NCQA determines the CAHPS 5.0H results portion of the score by comparing organization results with a national benchmark (the 90th percentile) and with national thresholds (the 75th, 50th and 25th percentiles). NCQA does not consider regional thresholds because regional variation in the data is not as significant. Organizations submit: Two rates for Prenatal and Postpartum Care (Medicaid only). Four rates for Comprehensive Diabetes Care. Two rates for Antidepressant Medication Management. Two rates for Follow-Up Care for Children Prescribed ADHD Medication.

3 3 Two rates for Pharmacotherapy Management of COPD Exacerbation. Three rates for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents. For these measures, each rate is scored against its individual threshold or benchmark. Individual scores are averaged to determine the overall score on each measure. The Comprehensive Diabetes Care average is doubled and counts as two measure scores. Medicare This document reports the national benchmarks and national and regional thresholds for HEDIS measures and Medicare CAHPS survey results required for accreditation of the Medicare product line. Medicaid This document reports national benchmarks and national thresholds for HEDIS measures and CAHPS survey results required for accreditation of the Medicaid product line. Medicaid product lines may elect to be scored on the adult version or on the child version of the CAHPS survey; they are not required to be scored on both. NCQA determines the HEDIS measures portion of the score by comparing an organization s Medicaid results with a national benchmark (the 90th percentile) and with national thresholds only (the 75th, 50th and 25th percentiles).

4 4 Adjusted Accreditation Points for Medicaid Plans by Region Because there is a limited number of Medicaid plans submitting audited HEDIS results, NCQA cannot publish regional thresholds for the HEDIS measures. However, NCQA developed adjustment factors using the commercial regional and national thresholds when substantial differences between national and regional measures were evident. Point adjustments for Medicaid plans are outlined below by region. Adjustments apply to all reporting products or to any combination of products. Medicaid plans should add the following percentage points to their rates (before scoring). Region 1: Connecticut, Maine, Rhode Island, Massachusetts, New Hampshire, Vermont HMO/POS/PPO Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis... add 3 percentage points Region 2: New Jersey, New York, Puerto Rico, Virgin Islands HMO/POS/PPO Breast Cancer Screening*... add 2 percentage points Comprehensive Diabetes Care Medical Attention for Nephropathy... add 2 percentage points Prenatal and Postpartum Care Postpartum Care... add 4 percentage points Region 3: Delaware, Maryland, Virginia, District of Columbia, Pennsylvania, West Virginia HMO/POS/PPO Comprehensive Diabetes Care HbA1c Testing... add 2 percentage points Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 2 percentage points Pharmacotherapy Management of COPD Exacerbation Bronchodilator... add 2 percentage points *Italicized measures in this section indicate added measures or a change in adjustment points from the initial 2014 Benchmarks and Thresholds memo.

5 5 Region 4: Alabama, Georgia, Mississippi, South Carolina, Florida, Kentucky, North Carolina, Tennessee HMO/POS/PPO Adult BMI Assessment... add 8 percentage points Antidepressant Medication Management Acute Phase... add 3 percentage points Antidepressant Medication Management Continuation Phase... add 3 percentage points Appropriate Treatment for Children With Upper Respiratory Infection... add 4 percentage points Comprehensive Diabetes Care Eye Exam... add 10 percentage points Comprehensive Diabetes Care HbA1c Poor Control... subtract 3 percentage points Comprehensive Diabetes Care Medical Attention for Nephropathy... add 2 percentage points Controlling High Blood Pressure... add 4 percentage points Follow-Up After Hospitalization for Mental Illness... add 9 percentage points Follow-Up Care for Children Prescribed ADHD Medication Initiation... add 2 percentage points Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 2 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 2 percentage points Pharmacotherapy Management of COPD Exacerbation Bronchodilator... add 5 percentage points Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid... add 2 percentage points Use of Imaging Studies for Low Back Pain... add 8 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile... add 10 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Nutrition... add 10 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Physical Activity... add 10 percentage points Region 5: Illinois, Michigan, Ohio, Indiana, Minnesota, Wisconsin HMO/POS/PPO Appropriate Testing for Children With Pharyngitis... add 3 percentage points Chlamydia Screening in Women... add 4 percentage points Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 2 percentage points Use of Spirometry Testing in the Assessment and Diagnosis of COPD... add 2 percentage points

6 6 Region 6: Arkansas, New Mexico, Texas, Louisiana, Oklahoma HMO/POS/PPO Adult BMI Assessment... add 4 percentage points Antidepressant Medication Management Acute Phase*... add 3 percentage points Antidepressant Medication Management Continuation Phase*... add 4 percentage points Appropriate Testing for Children With Pharyngitis... add 10 percentage points Appropriate Treatment for Children With Upper Respiratory Infection... add 9 percentage points Breast Cancer Screening*... add 3 percentage points Childhood Immunization Status Combination 2... add 6 percentage points Chlamydia Screening in Women... add 4 percentage points Cholesterol Management for Patients With Cardiovascular Conditions... add 2 percentage points Comprehensive Diabetes Care Eye Exam... add 10 percentage points Comprehensive Diabetes Care HbA1c Poor Control... subtract 6 percentage points Comprehensive Diabetes Care LDL-C Screening... add 3 percentage points Comprehensive Diabetes Care Medical Attention for Nephropathy... add 3 percentage points Controlling High Blood Pressure... add 6 percentage points Follow-Up After Hospitalization for Mental Illness... add 10 percentage points Follow-Up Care for Children Prescribed ADHD Medication Initiation... add 4 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 5 percentage points Pharmacotherapy Management of COPD Exacerbation Bronchodilator... add 3 percentage points Prenatal and Postpartum Care Postpartum Care... add 10 percentage points Use of Imaging Studies for Low Back Pain... add 3 percentage points Use of Spirometry Testing in the Assessment and Diagnosis of COPD... add 3 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile... add 10 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Nutrition... add 10 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Physical Activity... add 10 percentage points *Italicized measures in this section indicate added measures or a change in adjustment points from the initial 2014 Benchmarks and Thresholds memo.

7 7 Region 7: Iowa, Missouri, Kansas, Nebraska HMO/POS/PPO Antidepressant Medication Management Acute Phase... add 2 percentage points Antidepressant Medication Management Continuation Phase... add 5 percentage points Appropriate Testing for Children With Pharyngitis... add 5 percentage points Appropriate Treatment for Children With Upper Respiratory Infection... add 6 percentage points Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis... add 2 percentage points Chlamydia Screening in Women... add 7 percentage points Comprehensive Diabetes Care LDL-C Screening... add 2 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 3 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile... add 9 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Nutrition... add 10 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Physical Activity... add 6 percentage points Region 8: Colorado, North Dakota, Utah, Montana, South Dakota, Wyoming HMO/POS/PPO Breast Cancer Screening*... add 3 percentage points Chlamydia Screening in Women... add 7 percentage points Cholesterol Management for Patients With Cardiovascular Conditions... add 3 percentage points Comprehensive Diabetes Care LDL-C Screening... add 4 percentage points Follow-Up Care for Children Prescribed ADHD Medication Initiation... add 2 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 3 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile... add 10 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Nutrition... add 10 percentage points Region 9: American Samoa, California, Hawaii, Arizona, Guam, Nevada HMO/POS/PPO Antidepressant Medication Management Acute Phase*... add 4 percentage points Antidepressant Medication Management Continuation Phase*... add 5 percentage points Appropriate Testing for Children With Pharyngitis... add 10 percentage points Breast Cancer Screening... add 2 percentage points Childhood Immunization Status Combination 2... add 3 percentage points Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 2 percentage points Prenatal and Postpartum Care Postpartum Care... add 2 percentage points Use of Spirometry Testing in the Assessment and Diagnosis of COPD... add 4 percentage points *Italicized measures in this section indicate added measures or a change in adjustment points from the initial 2014 Benchmarks and Thresholds memo.

8 8 Region 10: Alaska, Oregon, Idaho, Washington HMO/POS/PPO Breast Cancer Screening*... add 2 percentage points Childhood Immunization Status Combination 2... add 3 percentage points Chlamydia Screening in Women... add 5 percentage points Cholesterol Management in Patients With Cardiovascular Conditions... add 3 percentage points Comprehensive Diabetes Care LDL-C Screening... add 3 percentage points Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 2 percentage points Prenatal and Postpartum Care Postpartum Care... add 2 percentage points Use of Spirometry Testing in the Assessment and Diagnosis of COPD... add 4 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile... add 9 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Nutrition... add 10 percentage points Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Physical Activity... add 10 percentage points *Italicized measures in this section indicate added measures or a change in adjustment points from the initial 2014 Benchmarks and Thresholds memo. Using Audited Data All national and regional benchmarks and thresholds provided in this document are based solely on audited data. Where the database included fewer than 20 reported audited rates for a region, thresholds are based on combined data, including an adjacent region. Each table indicates when a region was combined with another to determine thresholds. The regions used in this document align with the U.S. Department of Health and Human Services (HHS) regions and are listed below for reference. HHS Regions Region Number Region Name Covered States 1 Boston Connecticut, Maine, Rhode Island, Massachusetts, New Hampshire, Vermont 2 New York New Jersey, New York, Puerto Rico, Virgin Islands 3 Philadelphia Delaware, Maryland, Virginia, District of Columbia, Pennsylvania, West Virginia 4 Atlanta Alabama, Georgia, Mississippi, South Carolina, Florida, Kentucky, North Carolina, Tennessee 5 Chicago Illinois, Michigan, Ohio, Indiana, Minnesota, Wisconsin 6 Dallas Arkansas, New Mexico, Texas, Louisiana, Oklahoma 7 Kansas City Iowa, Missouri, Kansas, Nebraska 8 Denver Colorado, North Dakota, Utah, Montana, South Dakota, Wyoming 9 San Francisco American Samoa, California, Hawaii, Arizona, Guam, Nevada 10 Seattle Alaska, Oregon, Idaho, Washington

9 Commercial Benchmarks and Thresholds Commercial Adult BMI Assessment Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA NA NA NA Commercial Antidepressant Medication Management Effective Acute Phase Treatment 1 NA NA NA NA NA NA NA NA NA NA

10 10 Commercial Antidepressant Medication Management Effective Continuation Phase Treatment 1 NA NA NA NA NA NA NA NA NA NA Commercial Appropriate Testing for Children With Pharyngitis* Benchmarks and Thresholds (updated from 2013) 1 NA NA NA NA NA NA NA NA NA NA *If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points.

11 11 Commercial Appropriate Treatment for Children With Upper Respiratory Infection* 1 NA NA NA NA NA NA NA NA NA NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. Commercial Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA NA NA NA

12 12 Commercial Breast Cancer Screening Benchmarks and Thresholds (updated from 2013) 1 NA NA NA NA NA NA NA NA NA NA Commercial Childhood Immunization Status Combination 2 1 NA NA NA NA NA NA NA * NA NA * NA * Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

13 13 Commercial Chlamydia Screening in Women Total Rate Benchmarks and Thresholds (updated from 2013) 1 NA NA NA NA NA NA NA NA NA NA Commercial Cholesterol Management for Patients With Cardiovascular Conditions* 1 NA NA NA NA NA NA NA ** NA NA ** NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 50th percentile receive 100% of the regional points. ** Region 8 plans combined with Region 9 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

14 14 Commercial Colorectal Cancer Screening Benchmarks and Thresholds (updated from 2013) 1 NA NA NA NA NA NA NA NA NA NA Commercial Comprehensive Diabetes Care Eye Exam Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA * NA NA * NA * Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

15 15 Commercial Comprehensive Diabetes Care HbA1c Testing* 1 NA NA NA NA NA NA NA NA NA NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 50th percentile receive 100% of the regional points. Commercial Comprehensive Diabetes Care HbA1c Poor Control (>9.0%) Benchmarks and Thresholds (updated from 2013) 1 NA NA NA NA NA NA NA * NA NA * NA Note: A lower rate indicates better performance for this measure. * Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results

16 16 Commercial Comprehensive Diabetes Care LDL Screening Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA * NA NA * NA * Region 8 plans combined with Region 9 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results. Commercial Comprehensive Diabetes Care Medical Attention for Nephropathy* 1 NA NA NA NA NA NA NA NA NA NA * (NEW) If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points.

17 17 Commercial Controlling High Blood Pressure Benchmark and Threshold (no change from 2013) 1 NA NA NA NA NA NA * NA * NA NA * NA * Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results. Commercial Flu Vaccinations for Adults Ages Benchmark and Threshold (updated from 2013) 1 NA NA NA NA NA NA NA NA NA NA

18 18 Commercial Follow-Up After Hospitalization for Mental Illness 7-Day Rate 1 NA NA NA NA NA NA * NA NA NA NA *Region 7 plans combined with Region 8 plans for Region 7 results. Commercial Follow-Up for Children Prescribed ADHD Medication Initiation Phase Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA * NA NA NA *Region 8 plans combined with Region 7 plans for Region 8 results.

19 19 Commercial Follow-Up for Children Prescribed ADHD Medication Continuation & Maintenance Phase 1 NA NA NA NA NA * NA * NA * NA NA * NA * Region 6 plans combined with Region 4 plans for Region 6 results. Region 7 plans combined with Region 8 plans for Region 7 results. Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results. Commercial Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers and Tobacco Users to Quit Benchmark and Thresholds (no change from 2013) 1* NA * NA NA NA NA * NA NA * NA * NA * NA * Region 1 plans combined with Region 2 plans for Region 1 results. Region 2 plans combined with Region 1 plans for Region 2 results. Region 6 plans combined with Region 4 plans for Region 6 results. Region 8 plans combined with Region 7 plans for Region 8 results. Region 9 plans combined with Region 10 plans for Region 9 results. Region 10 plans combined with Region 9 plans for Region 10 results.

20 20 Commercial Persistence of Beta-Blocker Treatment After a Heart Attack* Benchmarks and Thresholds (updated from 2013) 1 NA NA NA NA NA NA ** NA ** NA NA ** NA * (NEW) If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. **Region 7 plans combined with Region 8 plans for Region 7 results. Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results. Commercial Pharmacotherapy Management of COPD Exacerbation Bronchodilator 1 NA NA NA NA NA * NA * NA * NA NA * NA * Region 6 plans combined with Region 4 plans for Region 6 results. Region 7 plans combined with Region 8 plans for Region 7 results. Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

21 21 Commercial Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid 1 NA NA NA NA NA * NA * NA * NA NA * NA * Region 6 plans combined with Region 4 plans for Region 6 results. Region 7 plans combined with Region 8 plans for Region 7 results. Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results. Commercial Prenatal and Postpartum Care Timeliness of Prenatal Care* 1 NA NA NA NA NA NA NA ** NA NA ** NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 25th percentile receive 100% of the regional points. Plans with reported rates below the regional 25th percentile receive 68% of the regional points. ** Region 8 plans combined with Region 9 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

22 22 Commercial Prenatal and Postpartum Care Postpartum Care 1 NA NA NA NA NA NA NA NA NA NA Commercial Use of Appropriate Medications for People With Asthma* 1 NA NA NA NA NA NA NA NA NA NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 25th percentile receive 100% of the regional points. Plans with reported rates below the regional 25th percentile receive 68% of the regional points.

23 23 Commercial Use of Imaging Studies for Low Back Pain 1 NA NA NA NA NA NA NA NA NA NA Commercial Use of Spirometry Testing in the Assessment and Diagnosis of COPD 1 NA NA NA NA NA NA NA * NA NA NA *Region 8 plans combined with Region 7 plans for Region 8 results.

24 24 Commercial Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile 1 NA NA NA NA NA NA NA * NA NA * NA * Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results. Commercial Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Nutrition 1 NA NA NA NA NA NA NA * NA NA * NA * Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

25 25 Commercial Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Physical Activity 1 NA NA NA NA NA NA NA * NA NA * NA * Region 8 plans combined with Region 7 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

26 Commercial Adult CAHPS Benchmarks/Thresholds Commercial Claims Processing Benchmarks and Thresholds (updated from 2013) Commercial Customer Service Benchmarks and Thresholds (updated from 2013) Commercial Getting Care Quickly Benchmarks and Thresholds (updated from 2013) Commercial Getting Needed Care Benchmarks and Thresholds (updated from 2013) Commercial How Well Doctors Communicate

27 27 Commercial Rating of All Health Care Commercial Rating of Health Plan Commercial Rating of Personal Doctor Commercial Rating of Specialist Seen Most Often

28 Medicare Benchmarks/Thresholds Medicare Adult BMI Assessment Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA NA NA NA Medicare Annual Monitoring for Patients on Persistent Medications (Total Rate)* Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA NA NA NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 25th percentile receive 100% of the regional points. Plans with reported rates below the regional 25th percentile receive 68% of the regional points.

29 29 Medicare Antidepressant Medication Management Acute Phase 1 NA NA NA NA NA NA NA NA NA NA Medicare Antidepressant Medication Management Continuation Phase 1 NA NA NA NA NA NA NA NA NA NA

30 30 Medicare Breast Cancer Screening 1 NA NA NA NA NA NA NA NA NA NA Medicare Cholesterol Management for Patients With Cardiovascular Conditions* Benchmark and Thresholds (no change from 2013) 1** NA NA ** NA NA NA ** NA ** NA ** NA NA ** NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. ** Region 1 plans combined with Region 2 plans for Region 1 results. Region 3 plans combined with Region 2 plans for Region 3 results. Region 6 plans combined with Region 7 plans for Region 6 results. Region 8 plans combined with Region 9 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

31 31 Medicare Colorectal Cancer Screening 1 NA NA NA NA NA NA NA NA NA NA Medicare Comprehensive Diabetes Care Eye Exam 1 NA NA NA NA NA NA NA NA NA NA

32 32 Medicare Comprehensive Diabetes Care HbA1c Testing* 1 NA NA NA NA NA NA NA NA NA NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 50th percentile receive 100% of the regional points. Medicare Comprehensive Diabetes Care HbA1c Poor Control (>9.0%)* Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA NA NA NA Note: A lower rate indicates better performance for this measure * If the 90th percentile is 10 or below and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or below the national 75th percentile receive 100% of the national points.

33 33 Medicare Comprehensive Diabetes Care LDL Screening* Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA NA NA NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. Medicare Comprehensive Diabetes Care Medical Attention for Nephropathy* 1 NA NA NA NA NA NA NA NA NA NA * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 50th percentile receive 100% of the regional points.

34 34 Medicare Controlling High Blood Pressure Benchmark and Thresholds (no change from 2013) 1 NA NA NA NA NA NA NA NA NA NA Medicare Flu Vaccinations for Adults Ages 65 and Older 1 NA NA NA NA NA NA NA NA NA NA

35 35 Medicare Follow-Up After Hospitalization for Mental Illness 7-day rate Benchmark and Thresholds (no change from 2013) 1* NA NA NA NA NA NA NA * NA NA NA * Region 1 plans combined with Region 2 plans for Region 1 results. Region 8 plans combined with Region 7 plans for Region 8 results. Medicare Glaucoma Screening In Older Adults 1 NA NA NA NA NA NA NA NA NA NA

36 36 Medicare Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers and Tobacco Users to Quit* 1 NA NA NA NA NA NA NA NA NA NA * (NEW) If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. Medicare Osteoporosis Management in Women Who Had a Fracture 1* NA NA NA NA NA NA NA * NA NA NA * Region 1 plans combined with Region 2 plans for Region 1 results. Region 8 plans combined with Region 7 plans for Region 8 results.

37 37 Medicare Persistence of Beta-Blocker Treatment After a Heart Attack* Benchmarks and Thresholds (updated from 2013) 1 NA NA NA NA NA NA NA ** NA NA ** NA * (Revised) If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the regional 50th percentile receive 100% of the regional points. ** Region 8 plans combined with Region 7 plans for Region 8 results. Medicare Pharmacotherapy Management of COPD Exacerbation Bronchodilator 1 NA NA NA NA NA NA NA * NA NA NA *Region 8 plans combined with Region 7 plans for Region 8 results.

38 38 Medicare Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid 1 NA NA NA NA NA NA NA * NA NA NA Medicare Pneumococcal Vaccination Status for Older Adults 1* NA NA * NA NA NA * NA NA * NA NA * NA * Region 1 plans combined with Region 2 plans for Region 1 results. Region 3 plans combined with Region 2 plans for Region 3 results. Region 6 plans combined with Region 7 plans for Region both results. Region 8 plans combined with Region 9 plans for Region 8 results. Region 10 plans combined with Region 9 plans for Region 10 results.

39 39 Medicare Use of Spirometry Testing in the Assessment and Diagnosis of COPD 1 NA NA NA NA NA NA NA * NA NA NA *Region 8 plans combined with Region 7 plans for Region 8 results. Medicare Use of High-Risk Medications in the Elderly Rate 1 1 NA NA NA NA NA NA NA NA NA NA Note: A lower rate indicates better performance for this measure

40 40 Medicare Use of High-Risk Medications in the Elderly Rate 2* 1 NA NA NA NA NA NA NA NA NA NA Note: A lower rate indicates better performance for this measure * If the 90th percentile is 10 or below and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or below the regional 25th percentile receive 100% of the regional points. Plans with reported rates above the regional 25 th percentile receive 68% of the regional points.

41 Medicare Adult CAHPS Benchmarks and Thresholds Medicare Getting Care Quickly Medicare Getting Needed Care Medicare How Well Doctors Communicate Medicare Rating of Personal Doctor Medicare Rating of All Health Care

42 42 Medicare Rating of Health Plan Medicare Rating of Specialist Seen Most Often

43 Medicaid Benchmarks/Thresholds Medicaid Adult BMI Assessment Benchmark and Thresholds (no change from 2013) Medicaid Antidepressant Medication Management Acute Phase Medicaid Antidepressant Medication Management Continuation Phase Medicaid Appropriate Testing for Children With Pharyngitis Benchmarks and Thresholds (updated from 2013) Medicaid Appropriate Treatment for Children With Upper Respiratory Infection* * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points.

44 44 Medicaid Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Medicaid Breast Cancer Screening Benchmarks and Thresholds (updated from 2013) Medicaid Childhood Immunization Status (Combination 2) Benchmark and Threshold (no change from 2013) Medicaid Chlamydia Screening in Women Total Rate Benchmark and Threshold (updated from 2013) Medicaid Cholesterol Management for Patients With Cardiovascular Conditions LDL-C Screening Benchmark and Thresholds (no change from 2013)

45 45 Medicaid Comprehensive Diabetes Care Eye Exam Benchmark and Threshold (updated from 2013) Medicaid Comprehensive Diabetes Care HbA1c Testing* Benchmark and Threshold (updated from 2013) * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. Medicaid Comprehensive Diabetes Care HbA1c Poor Control (>9.0%)* Benchmark and Threshold (updated from 2013) Note: A lower rate indicates better performance for this measure Medicaid Comprehensive Diabetes Care LDL Screening Benchmark and Thresholds (no change from 2013) Medicaid Comprehensive Diabetes Care Medical Attention for Nephropathy Benchmark and Threshold (updated from 2013) Medicaid Controlling High Blood Pressure Benchmark and Thresholds (no change from 2013)

46 46 Medicaid Follow-Up After Hospitalization for Mental Illness 7-Day Rate Benchmark and Threshold (no update from 2013) Medicaid Follow-Up for Children Prescribed ADHD Medication Initiation Phase Benchmark and Threshold (updated from 2013) Medicaid Follow-Up for Children Prescribed ADHD Medication Continuation & Maintenance Phase Benchmark and Threshold (updated from 2013) Medicaid Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers and Tobacco Users to Quit Medicaid Pharmacotherapy Management of COPD Exacerbation Bronchodilator* Benchmark and Threshold (updated from 2013) * (NEW) If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points.

47 47 Medicaid Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid Benchmark and Threshold (updated from 2013) Medicaid Prenatal and Postpartum Care (Timeliness of Prenatal Care)* Benchmark and Threshold (no change from 2013) * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. Medicaid Prenatal and Postpartum Care (Postpartum Care) Benchmark and Threshold (no change from 2013) Medicaid Use of Appropriate Medication for People With Asthma (Total rate)* Benchmarks and Thresholds (updated from 2013) * If the 90th percentile is 90 or above and the distribution for thresholds below the 90th percentile is within 5 percentage points, NCQA implements special scoring rules. For this measure, plans with reported rates at or above the national 75th percentile receive 100% of the national points. Medicaid Use of Imaging Studies for Low Back Pain Benchmark and Thresholds (no change from 2013)

48 48 Medicaid Use of Spirometry Testing in the Assessment and Diagnosis of COPD Benchmark and Thresholds (no change from 2013) Medicaid Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile Benchmark and Thresholds (no change from 2013) Medicaid Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Nutrition Benchmark and Thresholds (no change from 2013) Medicaid Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Physical Activity Benchmark and Thresholds (no change from 2013)

49 Medicaid Adult CAHPS Benchmarks and Thresholds Medicaid: Customer Service Benchmarks and Thresholds (updated from 2013) Medicaid Getting Care Quickly Benchmarks and Thresholds (updated from 2013) Medicaid Getting Needed Care Benchmarks and Thresholds (updated from 2013) Medicaid: How Well Doctors Communicate Medicaid: Rating of All Health Care Benchmarks and Thresholds (updated from 2013)

50 50 Medicaid Rating of Health Plan Medicaid: Rating of Personal Doctor Benchmarks and Thresholds (updated from 2013) Medicaid Rating of Specialist Seen Most Often Benchmarks and Thresholds (updated from 2013)

51 Medicaid Child CAHPS Benchmarks and Thresholds Medicaid: Customer Service Benchmarks and Thresholds (updated from 2013) Medicaid Getting Care Quickly Medicaid Getting Needed Care Benchmarks and Thresholds (updated from 2013) Medicaid: How Well Doctors Communicate Medicaid: Rating of All Health Care

52 52 Medicaid Rating of Health Plan Medicaid: Rating of Personal Doctor Medicaid Rating of Specialist Seen Most Often

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