Changes From the 2014 Memo
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- Amberlynn George
- 7 years ago
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1 TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Policy DATE: February 5, 2015 RE: 2015 Accreditation Benchmarks and Thresholds 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 2014 or no change from Refer to each measure for relevant footnotes and information about combining regions. 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. The final benchmarks and thresholds will be released in the 2015 Accreditation Benchmarks and Thresholds Mid-Year Update. All Medicaid data (including CAHPS Adult and Child survey data) will be reviewed and, if necessary, updated benchmarks will be included in the Mid-Year Update. In addition, the following measures will be reviewed and updated, if necessary: Childhood Immunization Status Combo 2 and Combo 10. Comprehensive Diabetes Care. Controlling High Blood Pressure. Human Papillomavirus Vaccine for Female Adolescents. Osteoporosis Management in Women Who Had a Fracture. Changes From the 2014 Memo We updated the Adjusted Accreditation Points for Medicaid Plans by Region section. Controlling High Blood Pressure will be scored NA for the Medicare product line for accreditation year 2015, regardless of the year when the health plan was accredited. 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 2015 Accreditation Benchmarks and Thresholds 2 Annual Monitoring for Patients on Persistent Medications will be scored NA for the Medicare product line for accreditation year Because this measure was retired from accreditation 2013 scoring, this only applies to plans accredited on the 2012 standards or earlier. Special scoring rules that were added or revised are noted throughout the tables. New Measures The following measures were added to accreditation scoring for 2015: Annual Dental Visits (Medicaid). Childhood Immunization Status Combo 10 (commercial, Medicaid). Comprehensive Diabetes Care BP Control <140/90 (all product lines). Comprehensive Diabetes Care HbA1c Control <8.0% (all product lines). Frequency of Ongoing Prenatal Care 81% of expected visits (Medicaid). Human Papillomavirus Vaccine for Female Adolescents (commercial, Medicaid). Immunizations for Adolescents Combo 1 (commercial, Medicaid). Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Engagement Rate (all product lines). Medication Management for People With Asthma 75% Rate (commercial, Medicaid). Retired Measures The following measures were retired from accreditation 2015 scoring. Organizations accredited on the 2014 standards or earlier will be scored using the organization s submitted rate for these measures. Childhood Immunization Status Combo 2 (commercial and Medicaid). Comprehensive Diabetes Care HbA1c Testing (all product lines). Use of Spirometry Testing in the Assessment and Diagnosis of COPD (all product lines). Use of Appropriate Medications for People With Asthma (Medicaid). CAHPS How Well Doctors Communicate (all product lines). The following measures were retired from the HEDIS measurement set and accreditation 2015 scoring. Organizations accredited on the 2014 standards or earlier will be scored NA. Cholesterol Management for Patients With Cardiovascular Conditions LDL-C Screening (all product lines) Comprehensive Diabetes Care LDL-C Screening (all product lines) Glaucoma Screening in Older Adults (Medicare)
3 2015 Accreditation Benchmarks and Thresholds 3 The following measures were retired from accreditation 2013 scoring and will not be scored for organizations accredited on the 2013, 2014 or 2015 standards. 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, 2014 or 2015 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). 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, 2014 or 2015 standards. Both rates will be scored for organizations accredited on the 2012 standards or earlier. Accreditation 2015 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). Five rates for Comprehensive Diabetes Care. Two rates for Antidepressant Medication Management. Two rates for Follow-Up Care for Children Prescribed ADHD Medication. 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.
4 2015 Accreditation Benchmarks and Thresholds 4 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).
5 2015 Accreditation Benchmarks and Thresholds 5 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 Childhood Immunization Status Combo add 4 percentage points Comprehensive Diabetes Care Blood Pressure Control <140/90... add 2 percentage points Comprehensive Diabetes Care Medical Attention for Nephropathy... add 2 percentage points Human Papillomavirus Vaccine for Female Adolescents... 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 Pharmacotherapy Management of COPD Exacerbation Bronchodilator... add 2 percentage points
6 2015 Accreditation Benchmarks and Thresholds 6 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 Childhood Immunization Status Combo add 3 percentage points Comprehensive Diabetes Care Blood Pressure Control <140/90... 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 Immunizations for Adolescents Combo 1... add 5 percentage points Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Engagement Rate... add 3 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 2 percentage points Persistence of Beta Blocker Treatment After a Heart Attack... add 4 percentage points Pharmacotherapy Management of COPD Exacerbation Bronchodilator... add 5 percentage points Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid... add 3 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 Use of Spirometry Testing in the Assessment and Diagnosis of COPD... add 2 percentage points
7 2015 Accreditation Benchmarks and Thresholds 7 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 3 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 Childhood Immunization Status Combination add 3 percentage points Chlamydia Screening in Women... add 5 percentage points Comprehensive Diabetes Care Blood Pressure Control <140/90... add 5 percentage points Comprehensive Diabetes Care Eye Exam... add 10 percentage points Comprehensive Diabetes Care HbA1c Control <8.0%... add 7 percentage points Comprehensive Diabetes Care HbA1c Poor Control... subtract 6 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 Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 3 percentage points Human Papillomavirus Vaccine for Female Adolescents... add 2 percentage points Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Engagement Rate... add 3 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 5 percentage points Medication Management for People With Asthma 75% Rate... add 3 percentage points Persistence of Beta Blocker Treatment After a Heart Attack... add 4 percentage points Pharmacotherapy Management of COPD Exacerbation Bronchodilator... add 3 percentage points Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid... add 2 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
8 2015 Accreditation Benchmarks and Thresholds 8 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 7 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 Childhood Immunization Status Combination add 4 percentage points Chlamydia Screening in Women... add 7 percentage points Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 4 percentage points Human Papillomavirus Vaccine for Female Adolescents... add 2 percentage points Immunizations for Adolescents Combo 1... add 10 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 3 percentage points Persistence of Beta Blocker Treatment After a Heart Attack... add 2 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 8 percentage points Comprehensive Diabetes Care HbA1c Control <8.0%... add 3 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 4 percentage points Immunizations for Adolescents Combo 1... add 4 percentage points Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Engagement Rate... add 2 percentage points Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit... add 3 percentage points Medication Management for People With Asthma 75% Rate... add 2 percentage points Persistence of Beta Blocker Treatment After a Heart Attack... add 2 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
9 2015 Accreditation Benchmarks and Thresholds 9 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 9 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 3 percentage points Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Engagement Rate... add 3 percentage points Medication Management for People With Asthma 75% Rate... add 4 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 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 Childhood Immunization Status Combination add 4 percentage points Chlamydia Screening in Women... add 6 percentage points Follow-Up Care for Children Prescribed ADHD Medication Continuation... add 2 percentage points Immunizations for Adolescents Combo 1... add 5 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 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.
10 2015 Accreditation Benchmarks and Thresholds 10 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
11 2015 Accreditation Benchmarks and Thresholds Commercial Benchmarks and Thresholds Commercial Adult BMI Assessment Benchmark and Thresholds (no change from 2014) 1 NA NA NA NA NA NA NA NA NA NA Commercial Antidepressant Medication Management Effective Acute Phase Treatment Benchmark and Thresholds (no change from 2014) 1 NA NA NA NA NA NA NA NA NA NA
12 2015 Accreditation Benchmarks and Thresholds 12 Commercial Antidepressant Medication Management Effective Continuation Phase Treatment Benchmark and Thresholds (no change from 2014) 1 NA NA NA NA NA NA NA NA NA NA Commercial Appropriate Testing for Children With Pharyngitis* Benchmarks and Thresholds (updated from 2014) 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.
13 2015 Accreditation Benchmarks and Thresholds 13 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 2014) 1 NA NA NA NA NA NA NA NA NA NA
14 2015 Accreditation Benchmarks and Thresholds 14 Commercial Breast Cancer Screening 1 NA NA NA NA NA NA NA NA NA NA Commercial Cervical Cancer Screening Benchmarks and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA
15 2015 Accreditation Benchmarks and Thresholds 15 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. Commercial Childhood Immunization Status Combination 10 Benchmarks and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA
16 2015 Accreditation Benchmarks and Thresholds 16 Commercial Chlamydia Screening in Women Total Rate Benchmarks and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA Commercial Colorectal Cancer Screening 1 NA NA NA NA NA NA NA NA NA NA
17 2015 Accreditation Benchmarks and Thresholds 17 Commercial Comprehensive Diabetes Care Blood Pressure Control (<140/90) Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA Commercial Comprehensive Diabetes Care Eye Exam Benchmark and Thresholds (no change from 2014) 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.
18 2015 Accreditation Benchmarks and Thresholds 18 Commercial Comprehensive Diabetes Care HbA1c Control (<8.0%) Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA Commercial Comprehensive Diabetes Care HbA1c Testing* Benchmark and Thresholds (no change from 2014) 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.
19 2015 Accreditation Benchmarks and Thresholds 19 Commercial Comprehensive Diabetes Care HbA1c Poor Control (>9.0%) 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 Commercial Comprehensive Diabetes Care Medical Attention for Nephropathy* Benchmark and Thresholds (no change from 2014) 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.
20 2015 Accreditation Benchmarks and Thresholds 20 Commercial Controlling High Blood Pressure Benchmark and Threshold (no change from 2014) 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 (no change from 2014) 1 NA NA NA NA NA NA NA NA NA NA
21 2015 Accreditation Benchmarks and Thresholds 21 Commercial Follow-Up After Hospitalization for Mental Illness 7-Day Rate Benchmark and Thresholds (no change from 2014) 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 2014) 1 NA NA NA NA NA NA NA * NA NA NA *Region 8 plans combined with Region 7 plans for Region 8 results.
22 2015 Accreditation Benchmarks and Thresholds 22 Commercial Follow-Up for Children Prescribed ADHD Medication Continuation & Maintenance Phase Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA * NA * NA NA * NA * 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 Human Papillomavirus Vaccine for Female Adolescents Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA
23 2015 Accreditation Benchmarks and Thresholds 23 Commercial Immunizations for Adolescents Combo 1 Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA Commercial Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Engagement Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA
24 2015 Accreditation Benchmarks and Thresholds 24 Commercial Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers and Tobacco Users to Quit Benchmark and Thresholds (no change from 2014) 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. Commercial Medication Management for People With Asthma 75% Rate Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA
25 2015 Accreditation Benchmarks and Thresholds 25 Commercial Persistence of Beta-Blocker Treatment After a Heart Attack* Benchmarks and Thresholds (updated from 2014) 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 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 Benchmark and Thresholds (no change from 2014) 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.
26 2015 Accreditation Benchmarks and Thresholds 26 Commercial Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA * NA * NA NA * NA * 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.
27 2015 Accreditation Benchmarks and Thresholds 27 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* Benchmark and Thresholds (no change from 2014) 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.
28 2015 Accreditation Benchmarks and Thresholds 28 Commercial Use of Imaging Studies for Low Back Pain Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA Commercial Use of Spirometry Testing in the Assessment and Diagnosis of COPD Benchmark and Thresholds (no change from 2014) 1 NA NA NA NA NA NA NA * NA NA NA *Region 8 plans combined with Region 7 plans for Region 8 results.
29 2015 Accreditation Benchmarks and Thresholds 29 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.
30 2015 Accreditation Benchmarks and Thresholds 30 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.
31 2015 Accreditation Benchmarks and Thresholds Commercial Adult CAHPS Benchmarks/Thresholds Commercial Claims Processing Benchmarks and Thresholds (updated from 2014) Commercial Customer Service Benchmarks and Thresholds (updated from 2014) Commercial Getting Care Quickly Benchmarks and Thresholds (updated from 2014) Commercial Getting Needed Care Benchmarks and Thresholds (updated from 2014) Commercial How Well Doctors Communicate
32 2015 Accreditation Benchmarks and Thresholds 32 Commercial Rating of All Health Care Commercial Rating of Health Plan Commercial Rating of Personal Doctor Commercial Rating of Specialist Seen Most Often
33 2015 Accreditation Benchmarks and Thresholds Medicare Benchmarks/Thresholds Medicare Adult BMI Assessment* Benchmark and Thresholds (updated from 2014) 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 Antidepressant Medication Management Acute Phase Benchmark and Thresholds (no change from 2014) 1 NA NA NA NA NA NA NA NA NA NA
34 2015 Accreditation Benchmarks and Thresholds 34 Medicare Antidepressant Medication Management Continuation Phase Benchmark and Thresholds (no change from 2014) 1 NA NA NA NA NA NA NA NA NA NA Medicare Breast Cancer Screening Benchmark and Thresholds (no change from 2014) 1 NA NA NA NA NA NA NA NA NA NA
35 2015 Accreditation Benchmarks and Thresholds 35 Medicare Colorectal Cancer Screening Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA Medicare Comprehensive Diabetes Care Blood Pressure Control (<140/90) Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA
36 2015 Accreditation Benchmarks and Thresholds 36 Medicare Comprehensive Diabetes Care Eye Exam Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA Medicare Comprehensive Diabetes Care HbA1c Control (<8.0%) Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA
37 2015 Accreditation Benchmarks and Thresholds 37 Medicare Comprehensive Diabetes Care HbA1c Testing* Benchmark and Thresholds (updated from 2014) 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 25th percentile receive 100% of the regional points. Plans with reported rates below the regional 25th percentile receive 68% of the regional points. Medicare Comprehensive Diabetes Care HbA1c Poor Control (>9.0%)* Benchmark and Thresholds (no change from 2014) 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.
38 2015 Accreditation Benchmarks and Thresholds 38 Medicare Comprehensive Diabetes Care Medical Attention for Nephropathy* Benchmark and Thresholds (updated from 2014) 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 Flu Vaccinations for Adults Ages 65 and Older Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA
39 2015 Accreditation Benchmarks and Thresholds 39 Medicare Follow-Up After Hospitalization for Mental Illness 7-day rate Benchmark and Thresholds (no change from 2014) 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 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Engagement Benchmark and Thresholds (new measure) 1 NA NA NA NA NA NA NA NA NA NA
40 2015 Accreditation Benchmarks and Thresholds 40 Medicare Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers and Tobacco Users to Quit* Benchmark and Thresholds (updated from 2014) 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 8 plans combined with Region 7 plans for Region 8 results. Medicare Osteoporosis Management in Women Who Had a Fracture Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA
41 2015 Accreditation Benchmarks and Thresholds 41 Medicare Persistence of Beta-Blocker Treatment After a Heart Attack* Benchmarks and Thresholds (updated from 2014) 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 1 plans combined with Region 2 plans for Region 1 results. Region 8 plans combined with Region 7 plans for Region 8 results. Medicare Pharmacotherapy Management of COPD Exacerbation Bronchodilator Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA * NA NA NA *Region 8 plans combined with Region 7 plans for Region 8 results.
42 2015 Accreditation Benchmarks and Thresholds 42 Medicare Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA Medicare Pneumococcal Vaccination Status for Older Adults Benchmark and Thresholds (updated from 2014) 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.
43 2015 Accreditation Benchmarks and Thresholds 43 Medicare Use of Spirometry Testing in the Assessment and Diagnosis of COPD Benchmark and Thresholds (no change from 2014) 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 Benchmark and Thresholds (updated from 2014) 1 NA NA NA NA NA NA NA NA NA NA Note: A lower rate indicates better performance for this measure
44 2015 Accreditation Benchmarks and Thresholds 44 Medicare Use of High-Risk Medications in the Elderly Rate 2* Benchmark and Thresholds (updated from 2014) 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 25th percentile receive 68% of the regional points.
45 2015 Accreditation Benchmarks and Thresholds 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
46 2015 Accreditation Benchmarks and Thresholds 46 Medicare Rating of Health Plan Medicare Rating of Specialist Seen Most Often
47 2015 Accreditation Benchmarks and Thresholds Medicaid Benchmarks/Thresholds Medicaid Adult BMI Assessment Benchmark and Thresholds (no change from 2014) Medicaid Annual Dental Visit Benchmark and Thresholds (new measure) Medicaid Antidepressant Medication Management Acute Phase Benchmark and Thresholds (no change from 2014) Medicaid Antidepressant Medication Management Continuation Phase Benchmark and Thresholds (no change from 2014) Medicaid Appropriate Testing for Children With Pharyngitis 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.
48 2015 Accreditation Benchmarks and Thresholds 48 Medicaid Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Benchmark and Thresholds (updated from 2014) Medicaid Breast Cancer Screening Medicaid Cervical Cancer Screening Benchmark and Threshold (updated from 2014) Medicaid Childhood Immunization Status (Combination 2) Benchmark and Threshold (no change from 2014) Medicaid Childhood Immunization Status (Combination 10) Benchmark and Threshold (new measure) Medicaid Chlamydia Screening in Women Total Rate Benchmark and Threshold (no change from 2014)
49 2015 Accreditation Benchmarks and Thresholds 49 Medicaid Comprehensive Diabetes Care Blood Pressure Control (<140/90) Benchmark and Threshold (new measure) Medicaid Comprehensive Diabetes Care Eye Exam Benchmark and Threshold (no change from 2014) Medicaid Comprehensive Diabetes Care HbA1c Control (<8.0%) Benchmark and Threshold (new measure) Medicaid Comprehensive Diabetes Care HbA1c Testing* Benchmark and Threshold (no change from 2014) * 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 (no change from 2014) Note: A lower rate indicates better performance for this measure Medicaid Comprehensive Diabetes Care Medical Attention for Nephropathy Benchmark and Threshold (no change from 2014)
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