NCQA Health Insurance Plan Ratings Methodology April 2014

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "NCQA Health Insurance Plan Ratings Methodology April 2014"

Transcription

1 NCQA Health Insurance Plan Ratings Methodology April 204

2 REVISION CHART Date Published December 203 April 204 Description Draft version Final version

3 TABLE OF CONTENTS Overview..... Ratings vs. rankings... 2 Summary... Ratings contact information... 3 How are plans rated? Overall rating Measures included Handling missing values Measure weights Calculating performance on NCQA Accreditation standards Final plan rating Measure and category 5 ratings Categories and subcategories Deriving ratings from individual results and national benchmarks How are plans displayed? What plans are rated or receive scores? Plans with partial data No data reported Additional rules Medicaid CAHPS and benchmarks Medicare CAHPS and Health Outcome Survey Special Needs Plans Schedule Appendix Definition of health insurance plans Measure lists... 5

4 Terminology and timing.. Ratings vs. rankings The methodology discussed in this document is for ratings that NCQA will provide privately to health plans with their publicly available rankings for After publishing the rankings results, NCQA will inform plans privately what their results would have been using this ratings methodology. This ratings methodology will replace rankings ratings will be published and available to the public, free of charge. This table summarizes the sequence: Published Provided to Plans Rankings Ratings Ratings For more information about the rankings that this ratings system will accompany in and replace in , visit ncqa.org/rankings. 2 Summary Health plans are rated in three categories: private plans that people enroll in through work or on their own; plans that serve Medicare beneficiaries in the Medicare Advantage program; and health maintenance organizations (HMO) for Medicaid beneficiaries. NCQA ratings are based on three types of quality measures: measures of clinical quality; measures of consumer satisfaction; and results from NCQA s review of a health plan s health quality processes. NCQA rates health plans that report quality information publicly. The clinical quality measures include prevention and treatment measures, which are a subset of the NCQA Healthcare Effectiveness Data and Information Set (HEDIS ) measures. Prevention measures assess the proportion of eligible members who received preventive services, like prenatal and postpartum care, immunizations and cancer screenings. Treatment measures assess the proportion of eligible members who received the recommended care for conditions such as diabetes, heart disease and mental illness. Consumer satisfaction measures come from the HEDIS survey measurement set Consumer Assessment of Healthcare Providers and Systems (CAHPS ) 2 a validated survey overseen by the Agency for Health Care Quality (AHRQ). Consumer satisfaction measures assess patient experience with care, including their experiences with doctors, services and customer service. Ratings contact information NCQA s Health Insurance Plan Ratings Help Desk: 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).

5 3 How are plans rated? 3.. Overall rating The overall rating is the weighted average of a plan s HEDIS and CAHPS measure ratings, plus accreditation standards (if the plan is accredited by NCQA), rounded to the nearest half point. Accreditation standards are given 0 percent of the weight of the valid HEDIS and CAHPS measures that a plan submits. The overall rating is based on performance on dozens of measures of care and is calculated on a scale 5 (5 is highest) in half points. Performance includes three subcategories (also scored 5): Consumer Satisfaction, Prevention and Treatment. Refer to Section 2..4: Measure weights. Consumer satisfaction: Patient-reported experiences of care, including experience with doctors, services and customer service (i.e., measures in the Consumer Satisfaction category). Rates for clinical measures: Prevention measures the proportion of eligible members who received preventive services. Treatment measures the proportion of eligible members who received recommended care for certain conditions (i.e., measures in the Prevention and Treatment categories). NCQA Accreditation standards score: Partial and proportionally adjusted results of NCQA Accreditation surveys (i.e., actual NCQA Accreditation standards score divided by the maximum possible NCQA Accreditation standards score) Measures included All publicly reportable clinical and CAHPS measures are eligible for inclusion. Selected measures have good differentiating properties, up-to-date evidence and high population impact. If a measure has process and control indicators, only the control indicator is included. If a measure has initiation and continuation indicators, only the initiation indicator is included. After data are received, NCQA removes measures from the methodology if less than 50 percent of the responses contain valid reported rates. Refer to Section 7: Appendix for the full list of measures and indicators for NCQA s Health Insurance Plan Ratings Handling missing values Measures that are not reported (NR) are given a rating of 0. Measures with missing values because of small denominators (NA) or because the plan did not offer the benefit (NB) are not used in the plan s composite or overall rating. A plan must have at least half of all measures by weight to receive an overall rating Measure weights Process measures (such as screenings) are given a weight of. Outcome measures like HbAc, LDL or blood pressure levels are given a weight of 3. Patient experience measures are given a weight of.5. Accreditation standards are weighted at 0 percent of the total weight of a plan s valid HEDIS and CAHPS measures Calculating performance on NCQA Accreditation standards NCQA evaluates health plan policies and processes for supporting quality improvement through accreditation to produce the standards score (i.e., score on the Accreditation standards) component of a plan s accreditation score. NCQA uses only the standards score in the ratings. (Because ratings calculations include HEDIS results, applying HEDIS results from NCQA Accreditation would be redundant.) The standards score is calculated for the ratings using the following formula: (Actual standards score)/(possible standards score) * 5 * 0% of the weight of the valid reported measures

6 Figure. NCQA Accreditation Standards Scoring for Rated and Partial Data Plans Accreditation Achieved Accreditation Standards Score Points in Ratings Score for Accreditation Health Plan 50 of 54.4 standards points (50/54.4) * 5 * 0% of the weight of valid reported measures Interim Actual points / possible points (actual/possible pts) * 5 * (/3) * 0% of the weight of valid reported measures New Health Plan 75 of 00 standards points (75/00) * 5 * 0% of the weight of valid reported measures Ratings Display NCQA Accreditation = Yes NCQA Accreditation = Yes Interim NCQA Accreditation = Yes In process No final standards score NCQA Accreditation = No (In process) Scheduled No final standards score NCQA Accreditation = No (Scheduled) None None NCQA Accreditation = No 3.2 Final plan rating NCQA displays ratings results by plan name in alphabetical order, in increments of 0.5.(e.g., 5, 4.5, 4). 3.3 Measure and category 5 ratings 3.3. Categories and subcategories NCQA combines and sorts measures into different categories according to conceptually related services. Ratings are displayed at the category, subcategory and individual measure level. A composite or subcategory rating is the weighted average of a plan s HEDIS and CAHPS measure ratings in the composite or subcategory. Ratings are calculated on a scale of 5 scale (higher is better) in half points. The weight of any NR measure is included. Refer to Section 7: Appendix for the list of measures Deriving ratings from individual results and national benchmarks The national 0th, 33.33rd, 66.67th and 90th percentiles of the measures will be used for the ratings. Measure ratings are calculated as whole numbers on a 5 scale. Rating A plan that is in the top decile of plans... 5 A plan that is in the top 3rd of plans, but not in the top 0th... 4 A plan in the middle 3rd of all plans... 3 A plan that is in the bottom 3rd of plans, but not in the bottom 0 percent... 2 A plan that is in the bottom 0 percent of plans... 2

7 4 How are plans displayed? 4. What plans are rated or receive scores? Plans with complete data are rated; plans with partial or no data are listed but not rated. NCQA shows these scores on a scale of 5 (5 is the highest), in increments of Plans with partial data Plans with partial data do not receive a rating, but NCQA lists them in the ratings and shows their scores on the measures they report. A plan is considered to have partial data if: It submits clinical and CAHPS measure data for public reporting, but has missing values (i.e., NA, NB, NR) in more than 50 percent of the weight of the measures used in the methodology. Refer to HEDIS Volume 2: Technical Specifications for information about missing values. It submits clinical data for public reporting but does not submit CAHPS data, or vice versa. It achieved NCQA Accreditation without HEDIS data (i.e., health plan accreditation [HPA] standards only) and has not submitted clinical or CAHPS data for public reporting No data reported Plans that submit results but do not report their data publicly, or plans that report no HEDIS or accreditation information to NCQA, are given a rating status of No Data Reported. Plans that fall into this category and have fewer than 8,000 members are omitted they are not rated and are not listed in displays related to the ratings. 5 Additional rules 5. Medicaid CAHPS and benchmarks Medicaid plans may choose the version of the CAHPS survey (or component ) they want scored: Adult CAHPS, Child CAHPS or Child With Chronic Conditions CAHPS (Child CCC) 3. Plans designate their CAHPS component when completing the 204 Healthcare Organization Questionnaire (HOQ). These designations may not be changed later and are benchmarked by component selected. Adult CAHPS benchmarks are based on the Adult rates only. Child and Child CCC CAHPS benchmarks are based on the combined general population rates for both Child components. 5.2 Medicare CAHPS and Health Outcome Survey Using Medicare CAHPS and Health Outcome Survey (HOS) data in the ratings depends on yearly approval from the Centers for Medicare & Medicaid Services (CMS). Because the submission schedule for Medicare CAHPS and HOS measures is different from the HEDIS submission schedule, NCQA uses the previous year s Medicare data for the measures in the CAHPS and HOS domain in Section 7.2 Appendix Medicare product line. For Medicare plans that were not required to submit CAHPS or HOS in the previous year, these measures are displayed as NA. 3 CAHPS components are described in more detail in HEDIS Volume 3: Specifications for Survey Measures. 3

8 6 Special Needs Plans Special Needs Plans (SNP) with all members categorized as special needs members are flagged in the ratings displays. 7 Schedule Find the 204 Rankings and Ratings schedule here. 4

9 8 Appendix 8. Definition of health insurance plans A health insurance plan is a type of coverage that pays for medical and surgical expenses incurred by its insured members. Health insurance plans include health maintenance organizations (HMO), point of service (POS) organizations and preferred provider organizations (PPO) with coverage in the 50 states. The District of Columbia and Puerto Rico are included in the final ratings reports. 8.2 Measure lists The following lists include all measures included in NCQA s Health Insurance Plan Ratings in the methodology for each product line. This list is subject to change. The Weight column indicates the weight of the item (maximum value = 3) in the overall score calculation. Note: Measures in italics are new and were not part of the ratings project s predecessor (NCQA s Health Insurance Plan Rankings ). Private/Commercial CONSUMER SATISFACTION Getting Care Getting Needed Care (Usually + Always) Getting Care Easily.5 CAHPS Getting Care Quickly (Usually + Always) Getting Care Quickly.5 CAHPS Satisfaction With Plan Physicians Rating of Doctor (9 + 0) Rating Personal Doctor.5 CAHPS Rating of Specialist (9 + 0) Rating Specialists.5 CAHPS Rating of Health Care (9 + 0) Rating Care Received.5 CAHPS Coordination of Care (Usually + Always) Coordination of Care.5 CAHPS Health Promotion and Education Health Promotion and Education.5 (Usually + Always) CAHPS Shared Decision Making (A Lot) Sahred Decision Making.5 CAHPS Satisfaction With Plan Services Customer Service (Usually + Always) Customer Service.5 CAHPS Claims Processing (Usually + Always) Handling Claims.5 CAHPS Rating of Health Plan (9 + 0) Rating Health Plan.5 CAHPS PREVENTION Children and Adolescent Well-Care W5 Well-Child Visits in the First 5 Months of Life W34 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life CAP Children s Access to Primary Care Practitioners 7 Years Well-Child Visits, Infants Utilization Well-Child Visits, Ages 3-6 Utilization Access for Children Ages 7- Access 5

10 PREVENTION AWC Adolescent Well-Care Visits Adolescent Well-Care Visits Utilization CIS Childhood Immunization Status (Combo 2) Early Immunizations 3 HEDIS IMA Immunizations for Adolescents (Combo ) Adolescent Immunizations 3 HEDIS Weight Assessment BMI Percentile Total BMI % for Children and Adolescents WCC Counseling for Nutrition Total Counseling on Nutrition Counseling for Physical Activity Total Counseling on Physical Activity HEDIS Women s Reproductive Health Prenatal Timeliness Timeliness of Prenatal Checkups PPC Postpartum Care Postpartum Care Access HPV Human Papillomavirus Vaccine for Female Human Papillomavirus Vaccine HEDIS Adolescents Cancer Screening BCS Breast Cancer Screening Breast Cancer Screening COL Colorectal Cancer Screening Colorectal Cancer Screening No Subcategory Rating ABA Adult BMI Assessment Reported Rate Adult BMI Assessment CHL Chlamydia Screening in Women Chlamydia Screening FVA Flu Shots for Adults Ages Flu Shots CAHPS TREATMENT Asthma AMR Asthma Medication Ratio (Total) Asthma Medication Ratio (Total) MMA Medication Management for People With Asthma Medication Compliance 75% (Total) HEDIS 6

11 TREATMENT Diabetes CDC Heart Disease Rate Eye Exams Retinal Eye Exams Rate Medical Attention for Nephropathy Monitoring Kidney Disease Rate <00 LDL-C Level LDL Cholesterol Control 3 Rate Blood Pressure Control <40/90 Blood Pressure Control (40/90) 3 Rate HbAc Control (<8.0%) Glucose Control 3 HEDIS CBP Controlling High Blood Pressure Controlling High Blood Pressure 3 HEDIS CMC Cholesterol Management for Patients With Cardiovascular Conditions PBH MSC Persistence of Beta-Blocker Treatment After a Heart Attack Medical Assistance With Smoking Cessation Advising Smokers to Quit Medical Assistance With Smoking Cessation Strategies for Quitting Medical Assistance With Smoking Cessation Medications for Quitting LDL Cholesterol Control 3 HEDIS Beta Blocker After Heart Attack Smoking Advice Stop-Smoking Strategies Stop-Smoking Medications CAHPS Mental and Behavioral Health ADD Follow-Up Care for Children Prescribed ADHD Medication Initiation AMM Antidepressant Medication Management FUH IET 7-Day Follow-Up After Hospitalization for Mental Illness Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Initiation of Treatment Alcohol or Drug Dependence Treatment Initiated Depression Adhering to Medication for 2 Weeks Follow-Up After Hospitalization for Mental Illness Alcohol or Drug Dependence Treatment Initiated Access 7

12 TREATMENT No Subcategory Rating AAB Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Appropriate Antibiotic Use, Adults With Acute Bronchitis ASP Aspirin Use and Discussion Use of Aspirin CAHPS CWP Appropriate Testing for Children With Pharyngitis LBP Use of Imaging Studies for Low Back Pain PCE URI Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid Pharmacotherapy Management of COPD Exacerbation Bronchodilator Appropriate Treatment for Children With Upper Respiratory Infection Medicare CONSUMER SATISFACTION Getting Care Appropriate Testing and Care, Children With Pharyngitis Use of Imaging Studies for Low Back Pain Steroid After Hospitalization for Acute COPD Bronchodilator After Hospitalization for Acute COPD Appropriate Antibiotic Use, Children With URI HEDIS Getting Needed Care (Usually + Always) Getting Care Easily.5 CAHPS Getting Care Quickly (Usually + Always) Getting Care Quickly.5 CAHPS Satisfaction With Plan Physicians Rating of Doctor (9 + 0) Rating Personal Doctor.5 CAHPS Rating of Specialist (9+ 0) Rating Specialists.5 CAHPS Rating of Health Care (9 + 0) Rating Care Received.5 CAHPS Satisfaction With Plan Services Customer Service (Usually + Always) Customer Service.5 CAHPS Rating of Health Plan (9 + 0) Rating Health Plan.5 CAHPS PREVENTION BCS Breast Cancer Screening Breast Cancer Screening COL Colorectal Cancer Screening Colorectal Cancer Screening ABA Adult BMI Assessment Reported Rate Adult BMI Assessment MCS Health Outcomes Mental (HOS Index) Evaluating Mental Health Status 3 HOS PCS Health Outcomes Physical (HOS Index) Evaluating Physical Health Status 3 HOS 8

13 PREVENTION FVO Flu Vaccinations for Adults Ages 65 and Older PNU Pneumococcal Vaccination Status for Older Adults Flu Shot CAHPS Pneumonia Shot CAHPS TREATMENT Diabetes Rate Eye Exams Retinal Eye Exams Rate Medical Attention for Nephropathy Monitoring Kidney Disease CDC Rate <00 LDL-C Level LDL Cholesterol Control 3 Rate Blood Pressure Control <40/90 Blood Pressure Control (40/90) 3 Rate HbAc Control (<8.0%) Glucose Control 3 HEDIS Heart Disease CBP Controlling High Blood Pressure Controlling High Blood Pressure 3 HEDIS CMC Cholesterol Management for Patients With Cardiovascular Conditions MSC Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit PBH Persistence of Beta-Blocker Treatment After a Heart Attack LDL Cholesterol Control 3 HEDIS Smoking Advice CAHPS Beta Blocker After Heart Attack Mental and Behavioral Health AMM Antidepressant Medication Management FUH 7-Day Follow-Up After Hospitalization for Mental Illness IET Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Initiation of Treatment Depression Adhering to Medication for 2 Weeks Follow-Up After Hospitalization for Mental Illness Alcohol or Drug Dependence Treatment Initiated Access No Subcategory Rating PCE Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid Pharmacotherapy Management of COPD Exacerbation Bronchodilater Steroid After Hospitalization for Acute COPD Bronchodilator After Hospitalization for Acute COPD HEDIS FRM Fall Risk Management Strategies Managing Risk of Falls HOS 9

14 TREATMENT OMW Osteoporosis Management in Women Who Had a Fracture Managing Osteoporosis in Women After Fracture OTO Osteoporosis Testing in Older Women Testing for Osteoporosis HOS DDE DAE Medicaid Potentially Harmful Drug-Disease Interactions in the Elderly (lower is better; invert before use) Use of High-Risk Medications in the Elderly (lower is better; invert before use) CONSUMER SATISFACTION Getting Care Avoiding Harmful Drug and Disease Interactions Avoiding High-Risk Medications Getting Needed Care (Usually + Always) Getting Care Easily.5 CAHPS Getting Care Quickly (Usually + Always) Getting Care Quickly.5 CAHPS Satisfaction With Plan Physicians Rating of Doctor (9 + 0) Rating Personal Doctor.5 CAHPS Rating of Specialist (9+ 0) Rating Specialists.5 CAHPS Rating of Health Care (9 + 0) Rating Care Received.5 CAHPS Coordination of Care (Usually + Always) Coordination of Care.5 CAHPS Health Promotion and Education (Usually + Always) Health Promotion & Education.5 CAHPS Shared Decision Making (A Lot) Shared Decision Making.5 CAHPS Satisfaction With Plan Services Customer Service (Usually + Always) Customer Service.5 CAHPS Rating of Health Plan (9 + 0) Rating Health Plan.5 CAHPS PREVENTION Children and Adolescent Well-Care W5 Well-Child Visits in the First 5 Months of Life W34 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life CAP Children s Access to Primary Care Practitioners 7 Years Well-Child Visits, Infants Utilization Well-Child Visits, Ages 3-6 Utilization Access for Children Ages 7- Access AWC Adolescent Well-Care Visits Adolescent Well-Care Visits Utilization CIS Childhood Immunization Status (Combo 2) Early Immunizations 3 HEDIS 0

15 CONSUMER SATISFACTION IMA Immunizations for Adolescents (Combo ) Adolescent Immunizations 3 HEDIS WCC Weight Assessment BMI Percentile Total BMI % for Children and Adolescents Counseling for Nutrition Total Counseling on Nutrition Counseling for Physical Activity Total Counseling on Physical Activity Women s Reproductive Health HEDIS PPC Prenatal Timeliness Timeliness of Prenatal Checkups Postpartum Care Postpartum Care Acess No Subcategory Rating BCS Breast Cancer Screening Breast Cancer Screening ABA Adult BMI Assessment Reported Rate Adult BMI Assessment CHL Chlamydia Screening in Women Chlamydia Screening HPV Human Papillomavirus Vaccine for Female Adolescents TREATMENT Asthma Human Papillomavirus Vaccine AMR Asthma Medication Ratio (Total) Asthma Medication Ratio (Total) MMA Medication Management for People With Asthma Medication Compliance 75% (Total) Diabetes Rate Eye Exams Retinal Eye Exams Rate Medical Attention for Nephropathy Monitoring Kidney Disease CDC Rate <00 LDL-C Level LDL Cholesterol Control 3 Rate Blood Pressure Control <40/90 Blood Pressure Control (40/90) 3 Rate HbAc Control (<8.0%) Glucose Control 3 HEDIS

16 TREATMENT Heart Disease CBP Controlling High Blood Pressure Controlling High Blood Pressure 3 HEDIS CMC Cholesterol Management for Patients With Cardiovascular Conditions MSC Medical Assistance With Smoking and Tobacco Use Cessation Advising Smokers to Quit Medical Assistance With Smoking and Tobacco Use Cessation Medications for Quitting Medical Assistance With Smoking and Tobacco Use Cessation Strategies for Quitting PBH Persistence of Beta-Blocker Treatment After a Heart Attack LDL Cholesterol Control 3 HEDIS Smoking Advice Stop-Smoking Medications Stop-Smoking Strategies CAHPS Beta Blocker After a Heart Attack Mental AMM Antidepressant Medication Management Acute Phase FUH Follow-Up After Hospitalization for Mental Illness IET Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Initiation of Treatment ADD Follow-Up Care for Children Prescribed ADHD Medication Initiation SSD Diabetes Screening for People With Schizophrenia and Bipolar Disorder SMD Diabetes Screening for People With Schizophrenia and Diabetes SMC Cardiovascular Monitoring for People With Schizophrenia and Cardiovascular Disorder SAA Adherence to Antipsychotic Medictions for Individuals With Schizophrenia Depression Adhering to Medication for 2 Weeks Follow-Up After Hospitalization for Mental Illness Alcohol or Drug Dependence Treatment Initiated Follow-Up After ADHD Diagnosis Diabetes Screening for People with Schizophrenia and Bipolar Disorder Diabetes Screening for People with Schizophrenia and Diabetes Cardiovascular Monitoring for People with Schizophrenia and Cardiovascular Disorder Adherence to Antipsychotic Medictions for Individuals with Schizophrenia HEDIS HEDIS HEDIS HEDIS 2

17 TREATMENT No Subcategory Rating ASP Aspirin Use and Discussion Use of Aspirin CAHPS PCE Pharmacotherapy Management of COPD Exacerbation Systemic Corticosteroid PCE Pharmacotherapy Management of COPD Exacerbation Bronchodilator AAB Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis CWP Appropriate Testing for Children With Pharyngitis LBP Use of Imaging Studies for Low Back Pain URI Appropriate Treatment for Children With Upper Respiratory Infection Steroid After Hospitalization for Acute COPD Bronchodilator After Hospitalization for Acute COPD Appropriate Antibiotic Use, Adults With Acute Bronchitis Appropriate Testing and Care, Children With Pharyngitis Use of Imaging Studies for Low Back Pain Appropriate Antibiotic Use, Children With URI 3

NCQA Health Insurance Plan Ratings Methodology March 2015

NCQA Health Insurance Plan Ratings Methodology March 2015 NCQA Health Insurance Plan Ratings Methodology March 205 REVISION CHART Date Published March 205 Description Final version (next update will be based on the 50% measure exclusion rule) TABLE OF CONTENTS

More information

Methodology Overview February 2014

Methodology Overview February 2014 February 2014 REVISION CHART Date Published February Description Initial Version ii TABLE OF CONTENTS Revision Chart... ii Table of Contents... iii 1 Summary... 1 Rankings contact information... 1 2 How

More information

Methodology Overview July 2013

Methodology Overview July 2013 July 2013 ii REVISION CHART Date Published May July Description Final version Final with updated measure list iii TABLE OF CONTENTS Revision Chart... iii Table of Contents... iv 1 Summary... 5 Rankings

More information

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

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

More information

HEDIS/CAHPS 101. August 13, 2012 Minnesota Measurement and Reporting Workgroup

HEDIS/CAHPS 101. August 13, 2012 Minnesota Measurement and Reporting Workgroup HEDIS/CAHPS 101 Minnesota Measurement and Reporting Workgroup Objectives Provide introduction to NCQA Identify HEDIS/CAHPS basics Discuss various components related to HEDIS/CAHPS usage, including State

More information

MEASURING CARE QUALITY

MEASURING CARE QUALITY MEASURING CARE QUALITY Region November 2015 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance

More information

11/2/2015 Domain: Care Coordination / Patient Safety

11/2/2015 Domain: Care Coordination / Patient Safety 11/2/2015 Domain: Care Coordination / Patient Safety 2014 CT Commercial Medicaid Compared to 2012 all LOB Medicaid Quality Compass Benchmarks 2 3 4 5 6 7 8 9 10 Documentation of Current Medications in

More information

SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES

SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling

More information

Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW

Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW Clinical Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW NQF 0105 PQRS 9 NQF 0002 PQRS 66 Antidepressant Medication Management Appropriate Testing for Children with Pharyngitis (2-18 years)

More information

SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES

SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling

More information

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement

More information

Medicare 2015 QI Program Evaluation

Medicare 2015 QI Program Evaluation Color Code: Red does not meet 5 star threshold, or target. Green meets or exceeds 5 star threshold/target. Improving or Maintaining Physical Health (HOS) Improving or Maintaining Mental Health (HOS) Diabetes

More information

A Detailed Data Set From the Year 2011

A Detailed Data Set From the Year 2011 2012 HEDIS 2012 A Detailed Data Set From the Year 2011 Commercial Product We are pleased to present the AvMed HEDIS 2012 Report, a detailed data set designed to give employers and consumers an objective

More information

SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES

SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling

More information

SUMMARY TABLE OF MEASURE CHANGES

SUMMARY TABLE OF MEASURE CHANGES SUMMARY TABLE OF MEASURE CHANGES Measure Name Effectiveness of Preventive Care Adult BMI Assessment Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Childhood

More information

HEDIS 2010 Summary Table of Measures, Product Lines and Changes Applicable to:

HEDIS 2010 Summary Table of Measures, Product Lines and Changes Applicable to: HEDIS 2010 Summary Table of Measures, Product Lines and Changes Adult BMI Assessment Added CPT codes 99341 99345, 99347 99350 to Table ABA-A. Added ICD-9-CM Diagnosis codes 678, 679 to Table ABA-C. Weight

More information

SUMMARY TABLE OF MEASURE CHANGES

SUMMARY TABLE OF MEASURE CHANGES Summary Table of Measure 1 SUMMARY TABLE OF MEASURE CHANGES Guidelines for Physician Measurement Effectiveness of Preventive Care Guidelines for Physician Effectiveness of Care Adult BMI Assessment Weight

More information

Colorado Medicaid HEDIS 2014 Results STATEWIDE AGGREGATE REPORT

Colorado Medicaid HEDIS 2014 Results STATEWIDE AGGREGATE REPORT Colorado Medicaid HEDIS 2014 Results STATEWIDE AGGREGATE REPORT December 2014 This report was produced by Health Services Advisory Group, Inc. for the Colorado Department of Health Care Policy and Financing.

More information

Medicare 2013 QI Program Evaluation

Medicare 2013 QI Program Evaluation #1 Priority Measures Diabetes Medication Adherence D 3 69% 71% High Risk Meds in the Elderly D 3 8% 3% Sleep medications were added to the measure after the 2013 formulary was accepted. A number of high

More information

Performance Results for Health Insurance Plans

Performance Results for Health Insurance Plans WASHINGTON STATE COMMON MEASURE SET FOR HEALTH CARE QUALITY AND COST Performance Results for Health Insurance Plans DECEMBER 2015 Table of Contents Introduction... 3 About the Results... 4 How to Read

More information

Quality Improvement Program

Quality Improvement Program Quality Improvement Program Section M-1 Additional information on the Quality Improvement Program (QIP) and activities is available on our website at www.molinahealthcare.com Upon request in writing, Molina

More information

AETNA BETTER HEALTH OF MISSOURI

AETNA BETTER HEALTH OF MISSOURI Aetna Better Health of Missouri 10 South Broadway, Suite 1200 St. Louis, MO 63102 800-566-6444 AETNA BETTER HEALTH OF MISSOURI HEDIS Quick Reference Billing Guide 2014 Diagnosis and/or procedure codes

More information

QUALITY MANAGEMENT PROGRAM 2015 EVALUATION

QUALITY MANAGEMENT PROGRAM 2015 EVALUATION QUALITY MANAGEMENT PROGRAM 2015 EVALUATION Tim Gutshall, MD Vice President & Chief Medical Officer Wellmark Blue Cross and Blue Shield Table of Contents Purpose... 2 Scope of Work... 2 Objectives... 2

More information

2011 Comprehensive Performance Report Commercial HMO, POS, and PPO Health Benefit Plans in Maryland

2011 Comprehensive Performance Report Commercial HMO, POS, and PPO Health Benefit Plans in Maryland 2011 Comprehensive Performance Report Commercial HMO, POS, and PPO Health Benefit Plans in Maryland Maryland Health Care Commission Marilyn Moon, PhD Chair Garret A. Falcone, NHA Vice Chair Reverend Robert

More information

A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS

A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS The matrix below provides a comparison of all measures included in Medi-Cal P4P programs and the measures includes in DHCS s External Accountability

More information

Report on comparing quality among Medicare Advantage plans and between Medicare Advantage and fee-for-service Medicare

Report on comparing quality among Medicare Advantage plans and between Medicare Advantage and fee-for-service Medicare O N L I N E A P P E N D I X E S 6 Report on comparing quality among Medicare Advantage plans and between Medicare Advantage and fee-for-service Medicare 6-A O N L I N E A P P E N D I X Current quality

More information

HEdis Code Quick Reference Guide Disease Management Services

HEdis Code Quick Reference Guide Disease Management Services HEdis Code Quick Reference Guide Disease Management Services Respiratory Conditions Appropriate Testing for Children With Pharyngitis (ages 2-18) [Commercial, Medicaid] Appropriate Treatment (no antibiotic)

More information

AmeriHealth Caritas Northeast. Aetna Better Health. PA Performance. Measure. AmeriHealth Caritas Northeast. Aetna Better Health

AmeriHealth Caritas Northeast. Aetna Better Health. PA Performance. Measure. AmeriHealth Caritas Northeast. Aetna Better Health Asthma Use of Appropriate Medications for People with Asthma, Ages 5 to 64 Medication Management for People with Asthma (75% compliance), Ages 5 to 64 Annual Number of Asthma Patients with One or More

More information

Total Health Quality Indicators For Providers 2015

Total Health Quality Indicators For Providers 2015 Total Health Quality Indicators For Providers 2015 Adult- Preventive Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 BMI Assessment BMI Recording 18-74 yrs Yearly G8417, G8418, G8420

More information

Achieving Quality and Value in Chronic Care Management

Achieving Quality and Value in Chronic Care Management The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

More information

MEASURE C01: Breast Cancer Screening. MEASURE C02: Colorectal Cancer Screening. MEASURE C07: Adult BMI Assessment

MEASURE C01: Breast Cancer Screening. MEASURE C02: Colorectal Cancer Screening. MEASURE C07: Adult BMI Assessment HEDIS: THESE ARE THE S WE CAN HAVE THE GREATEST IMPACT ON! Healthcare Effectiveness Data and Information Set. Measures health plan performance on health care and service. HEDIS data are collected through

More information

Contra Cost Health Plan Quality Program Summary November, 2013

Contra Cost Health Plan Quality Program Summary November, 2013 Contra Cost Health Plan Quality Program Summary November, 2013 Mission Statement: Contra Costa Health Plan, along with our community and county health care providers, is committed to ensure our diverse

More information

2010 QARR QUICK REFERENCE GUIDE Adults

2010 QARR QUICK REFERENCE GUIDE Adults 2010 QARR QUICK REFERENCE GUIDE Adults ADULT MEASURES (19 through 64 years) GUIDELINE HEDIS COMPLIANT CPT/ICD9 CODES DOCUMENTATION TIPS Well Care Access to Ambulatory Care Ensure a preventive or other

More information

NCQA Health Plan Accreditation. Creating Value by Improving Health Care Quality

NCQA Health Plan Accreditation. Creating Value by Improving Health Care Quality NCQA Health Plan Accreditation Creating Value by Improving Health Care Quality NCQA Health Plan Accreditation Creating Value by Improving Health Care Quality Purchasers, consumers and health plans pay

More information

CREATING A POPULATION HEALTH PLAN FOR VIRGINIA

CREATING A POPULATION HEALTH PLAN FOR VIRGINIA CREATING A POPULATION HEALTH PLAN FOR VIRGINIA Life Expectancy 1900, 2013 1900 50.6 years old 2013 78.8 years old 0 20 40 60 80 100 Age (Years) Source: http://ucatlas.ucsc.edu/health.php Year - 2000 Source:

More information

Texas Medicaid Managed Care and Children s Health Insurance Program

Texas Medicaid Managed Care and Children s Health Insurance Program Texas Medicaid Managed Care and Children s Health Insurance Program External Quality Review Organization Summary of Activities and Trends in Healthcare Quality Contract Year 2013 Measurement Period: September

More information

Ohio Health Homes Learning Community Meeting. Overview of Health Homes Measures

Ohio Health Homes Learning Community Meeting. Overview of Health Homes Measures Ohio Health Homes Learning Community Meeting Overview of Health Homes Measures Tuesday, March 5, 2013 Presenter: Amber Saldivar, MHSM Associate Director, Informatics Analysis Health Services Advisory Group,

More information

Highlighting HEDIS 2015

Highlighting HEDIS 2015 Provider Remittance How to read your Facility Provider Remittance Ancillary Providers: Refer to this guide only when working with Facility providers. Highlighting HEDIS 2015 This booklet captures articles

More information

The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including

The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including charts, tables, and graphics may be difficult to read using

More information

2016 HEDIS /QRS/QARR/EES Physician Documentation Guidelines and Administrative Codes

2016 HEDIS /QRS/QARR/EES Physician Documentation Guidelines and Administrative Codes 2016 HEDIS /QRS/QARR/EES Physician Documentation Guidelines and Administrative Codes This document contains a description of HEDIS and other quality of care measures and includes suggestions and/or recommendations

More information

Focus on Obesity and on Medicare Plan Improvement

Focus on Obesity and on Medicare Plan Improvement Focus on Obesity and on Medicare Plan Improvement The State of Health Care Quality 2012 Focus on Obesity and on Medicare Plan Improvement The State of Health Care Quality 2012 2 n at i o n a l c o m m

More information

Explanation of CMS Proposed Performance Measurement Framework for ACOs and Comparison with IHA P4P Measure Set April 2011

Explanation of CMS Proposed Performance Measurement Framework for ACOs and Comparison with IHA P4P Measure Set April 2011 Explanation of CMS Proposed Performance ment Framework for ACOs and Comparison with IHA P4P Set April 2011 This briefing outlines Section II E ( and Other Reporting Requirements) of the Shared Savings

More information

Care Gap Care Reminder Description Reference 900-2035-1210. Cardiovascular Persistence of Beta- Blocker Treatment After a Heart Attack (PBH)

Care Gap Care Reminder Description Reference 900-2035-1210. Cardiovascular Persistence of Beta- Blocker Treatment After a Heart Attack (PBH) Below is a list of the current Care Reminders shown in the Patient Care Summary Clinical Messaging section of the Availity web portal. These Florida Blue clinical alerts are based on claim data and are

More information

Vermont ACO Shared Savings Program Quality Measures: Recommendations for Year 2 Measures from the VHCIP Quality and Performance Measures Work Group

Vermont ACO Shared Savings Program Quality Measures: Recommendations for Year 2 Measures from the VHCIP Quality and Performance Measures Work Group Vermont ACO Shared Savings Program Quality Measures: Recommendations for Year 2 Measures from the VHCIP Quality and Performance Measures Work Group Presentation to VHCIP Steering Committee August 6, 2014

More information

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile (Total)

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile (Total) Appendix C: New Performance Measures DOM Performance Measures Relevant HEDIS Measure(s) HEDIS 2012 Benchmark 50 th Percentile The 50 th percentile benchmarks are an indicator that half of the health plans

More information

Behavioral Health Quality Standards for Providers

Behavioral Health Quality Standards for Providers Behavioral Health Quality Standards for Providers TABLE OF CONTENTS I. Behavioral Health Quality Standards Access Standards A. Access Standards B. After-Hours C. Continuity and Coordination of Care 1.

More information

Mid-Hudson Adherence to Antipsychotic Medications for People Living With Schizophrenia

Mid-Hudson Adherence to Antipsychotic Medications for People Living With Schizophrenia Adherence to Antipsychotic Medications for People Living With Schizophrenia 83 81 71 70 68 68 66 71 A. Behavioral Health 880 151 396 134 325 41 317 65 63 The percentage of recipients living with schizophrenia,

More information

2015 HEDIS/CAHPS Effectiveness of Care Report for 2014 Service Measures Oregon, Idaho and Montana Commercial Business

2015 HEDIS/CAHPS Effectiveness of Care Report for 2014 Service Measures Oregon, Idaho and Montana Commercial Business 2015 HEDIS/CAHPS Effectiveness of Care Report for 2014 Service Measures Oregon, Idaho and Montana Commercial Business About HEDIS The Healthcare Effectiveness Data and Information Set (HEDIS 1 ) is a widely

More information

2016 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set

2016 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set 2016 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set *Measures collected with medical record review. Red= new/addition to measures Blue= Medicare only Prevention and Screening Measure

More information

HEDIS Code Quick Reference Guide Preventive/Ambulatory Services

HEDIS Code Quick Reference Guide Preventive/Ambulatory Services HEDIS Code Quick Reference Guide Preventive/Ambulatory Services Child/Adolescent Care Well-Child Visits in the First 15 Months of Life [Commercial, Medicaid] Well-Child Visits in the Third, Fourth, Fifth

More information

2013 ACO Quality Measures

2013 ACO Quality Measures ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating

More information

1. How are you using health IT enabled clinical quality measures for internal quality improvement efforts and patients care?

1. How are you using health IT enabled clinical quality measures for internal quality improvement efforts and patients care? 1. How are you using health IT enabled clinical quality measures for internal quality improvement efforts and patients care? Sharp Rees-Stealy medical group (SRSMG), a 400-physician multispecialty group

More information

PBM s: Helping to Improve MA-PD Star Scores. James Brehany PharmD, PA-C, JD Associate Vice President, Pharmacy Services PerformRx

PBM s: Helping to Improve MA-PD Star Scores. James Brehany PharmD, PA-C, JD Associate Vice President, Pharmacy Services PerformRx PBM s: Helping to Improve MA-PD Star Scores James Brehany PharmD, PA-C, JD Associate Vice President, Pharmacy Services PerformRx CMS Star Rating System Instituted in 2008 Applicable to MA plans, MA-PD

More information

Improving Quality and Patient Experience. The State of Health Care Quality 2013

Improving Quality and Patient Experience. The State of Health Care Quality 2013 Improving Quality and Patient Experience The State of Health Care Quality 2013 Improving Quality and Patient Experience The State of Health Care Quality 2013 2 n at i o n a l c o m m i t t e e f o r q

More information

MaineCare Value Based Purchasing Initiative

MaineCare Value Based Purchasing Initiative MaineCare Value Based Purchasing Initiative The Accountable Communities Strategy Jim Leonard, Deputy Director, MaineCare Peter Kraut, Acting Accountable Communities Program Manager Why Value-Based Purchasing

More information

Continuous Improvement and the Expansion of Quality Measurement

Continuous Improvement and the Expansion of Quality Measurement Continuous Improvement and the Expansion of Quality Measurement T h e S t a t e o f H e a l t h C a r e Q u a l i t y 2 0 1 1 Continuous Improvement and the Expansion of Quality Measurement T h e S t a

More information

2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide

2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide 2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide HEDIS Measure: Test/Care Needed for Compliance Adult BMI Assessment Individuals ages 18-74 Documentation of BMI and

More information

HEDIS, STAR Performance Metrics. Sheila Linehan, RN,MPH, CPHQ Director of QM, Horizon BCBSNJ July 16, 2014

HEDIS, STAR Performance Metrics. Sheila Linehan, RN,MPH, CPHQ Director of QM, Horizon BCBSNJ July 16, 2014 HEDIS, STAR Performance Metrics Sheila Linehan, RN,MPH, CPHQ Director of QM, Horizon BCBSNJ July 16, 2014 Goals Discuss what HEDIS and Star Metrics are Discuss their impact on Health Plans Discuss their

More information

How we measure up 0813 25346WVAMENUNC 01/14

How we measure up 0813 25346WVAMENUNC 01/14 Quality Improvement Program How we measure up At UniCare Health Plan of West Virginia Inc., we focus on helping our members get healthy and stay healthy. To help us serve you the best we can, each year

More information

8/14/2012 California Dual Demonstration DRAFT Quality Metrics

8/14/2012 California Dual Demonstration DRAFT Quality Metrics Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years

More information

Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year

Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2014 benchmarks for ACO-9 and ACO-10 quality

More information

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE

More information

See page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++

See page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++ Hospitalizations Inpatient Utilization General Hospital/Acute Care (IPU) * This measure summarizes utilization of acute inpatient care and services in the following categories: Total inpatient. Medicine.

More information

Shoot For The Stars. Medicare Advantage Plans. Quality Scores Drive Participation 1

Shoot For The Stars. Medicare Advantage Plans. Quality Scores Drive Participation 1 Shoot For The Stars Medicare Advantage Plans Quality Scores Drive Participation 1 Stars Rating System CMS rates Medicare Advantage Plans (HMO, PPO, and PFFS) on a 1 to 5 Star scale. Star ratings can be

More information

Key Performance Measures for School-Based Health Centers

Key Performance Measures for School-Based Health Centers Key Performance Measures for School-Based Health Centers As health care reform continues to take shape and additional provisions of the Affordable Care Act are implemented, there is an increasing demand

More information

Healthcare Effectiveness Data and Information Set (HEDIS ) Guide

Healthcare Effectiveness Data and Information Set (HEDIS ) Guide Healthcare Effectiveness Data and Information Set (HEDIS ) Guide Clinical ALL ADULTS Access to preventive/ ambulatory health services Smoking and Tobacco Use Cessation [S] Aspirin Use and Discussion [S]

More information

HEDIS CY2012 New Measures

HEDIS CY2012 New Measures HEDIS CY2012 New Measures TECHNICAL CONSIDERATIONS FOR NEW MEASURES The NCQA Committee on Performance Measurement (CPM) approved five new measures for HEDIS 2013 (CY2012). These measures provide feasible

More information

New York Consumer Guide to Health Insurance Companies. New York State Andrew M. Cuomo, Governor

New York Consumer Guide to Health Insurance Companies. New York State Andrew M. Cuomo, Governor New York Consumer Guide to Health Insurance Companies 2012 New York State Andrew M. Cuomo, Governor Table of Contents ABOUT THIS GUIDE... 2 COMPLAINTS... 3 PROMPT PAY COMPLAINTS... 8 INTERNAL APPEALS...

More information

2015 Health Plan Comparison in New York State

2015 Health Plan Comparison in New York State New York State Department of Health 2015 Health Comparison in New York State A Report Comparing Quality and Satisfaction Performance Results for Health s QARR Report Series Issue 2 of 5 health.ny.gov Table

More information

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we

More information

The Star Treatment: Estimating the Impact of Star Ratings on Medicare. Advantage Enrollments. Appendices

The Star Treatment: Estimating the Impact of Star Ratings on Medicare. Advantage Enrollments. Appendices The Star Treatment: Estimating the Impact of Star Ratings on Medicare Advantage Enrollments. Appendices Michael Darden Department of Economics Tulane University Ian M. McCarthy Department of Economics

More information

2013 Health Plan Comparison in New York State

2013 Health Plan Comparison in New York State QARR Report Series, Issue No. 2 of 5 2013 Health Comparison in New York State 2013 A r e p o r t c o m p a r i n g Q u a l i t y a n d S a t i s f a c t i o n P e r f o r m a n c e r e s u l t s f o r

More information

More than a score: working together to achieve better health outcomes while meeting HEDIS measures

More than a score: working together to achieve better health outcomes while meeting HEDIS measures NEVADA ProviderNews Vol. 3 2014 More than a score: working together to achieve better health outcomes while meeting HEDIS measures We know you ve heard of Healthcare Effectiveness Data and Information

More information

CQMs. Clinical Quality Measures 101

CQMs. Clinical Quality Measures 101 CQMs Clinical Quality Measures 101 BASICS AND GOALS In the past 10 years, clinical quality measures (CQMs) have become an integral component in the Centers for Medicare & Medicaid Services (CMS) drive

More information

Performance Evaluation Report Kaiser Prepaid Health Plan (KP Cal, LLC) Marin and Sonoma Counties July 1, 2009 June 30, 2010

Performance Evaluation Report Kaiser Prepaid Health Plan (KP Cal, LLC) Marin and Sonoma Counties July 1, 2009 June 30, 2010 Performance Evaluation Report Kaiser Prepaid Health Plan (KP Cal, LLC) Marin and Sonoma Counties July 1, 2009 June 30, 2010 Medi-Cal Managed Care Division California Department of Health Care Services

More information

Making the Grade! A Closer Look at Health Plan Performance

Making the Grade! A Closer Look at Health Plan Performance Primary Care Update August 2011 Making the Grade! A Closer Look at Health Plan Performance HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized measures designed to track

More information

New York Consumer Guide to Health Insurance Companies. New York State Andrew M. Cuomo, Governor

New York Consumer Guide to Health Insurance Companies. New York State Andrew M. Cuomo, Governor New York Consumer Guide to Health Insurance Companies 2014 New York State Andrew M. Cuomo, Governor Table of Contents ABOUT THIS GUIDE...2 COMPLAINTS...3 PROMPT PAY COMPLAINTS... 8 INTERNAL APPEALS...

More information

2015 Michigan Department of Health and Human Services Adult Medicaid Health Plan CAHPS Report

2015 Michigan Department of Health and Human Services Adult Medicaid Health Plan CAHPS Report 2015 State of Michigan Department of Health and Human Services 2015 Michigan Department of Health and Human Services Adult Medicaid Health Plan CAHPS Report September 2015 Draft Draft 3133 East Camelback

More information

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology The chart below lists the measures (and specialty exclusions) that eligible providers must demonstrate

More information

Blue Care Network. 2014 Performance Recognition Program. Performance Recognition Program Commercial HMO Incentive Materials 2014

Blue Care Network. 2014 Performance Recognition Program. Performance Recognition Program Commercial HMO Incentive Materials 2014 2014 erformance Recognition rogram Blue Care Network erformance Recognition rogram Commercial HMO Incentive Materials 2014 2014 Commercial HMO R Materials December 2013 Dear BCN Affiliated rimary Care

More information

Patient Centered Medical Home

Patient Centered Medical Home Patient Centered Medical Home 2013 2014 Program Overview Florida Blue is a trade name of Blue Cross and Blue Shield of Florida Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.

More information

Table 1 Performance Measures. Quality Monitoring P4P Yr1 Yr2 Yr3. Specification Source. # Category Performance Measure

Table 1 Performance Measures. Quality Monitoring P4P Yr1 Yr2 Yr3. Specification Source. # Category Performance Measure Table 1 Performance Measures # Category Performance Measure 1 Behavioral Health Risk Assessment and Follow-up 1) Behavioral Screening/ Assessment within 60 days of enrollment New Enrollees who completed

More information

2012 Physician Quality Reporting System:

2012 Physician Quality Reporting System: DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Official CMS Information for Medicare Fee-For-Service Providers 2012 Physician Quality : Medicare Electronic Health Record

More information

2015 Medicare CAHPS At-A-Glance Report

2015 Medicare CAHPS At-A-Glance Report 2015 Medicare CAHPS At-A-Glance Report Advantage by Bridgeway Health Solutions CMS MA PD Contract: H5590 Project Number(s): 30103743 Current data as of: 07/01/2015 1965 Evergreen Boulevard Suite 100, Duluth,

More information

Vermont ACO Shared Savings Program: Recommendations for Year 2 Quality Measures

Vermont ACO Shared Savings Program: Recommendations for Year 2 Quality Measures Vermont ACO Shared Savings Program: Recommendations for Year 2 Quality Measures Green Mountain Care Board October 9, 2014 10/9/2014 1 ACOs & SSPs Accountable Care Organizations (ACOs) are composed of and

More information

ACO Name and Location Allina Health Minneapolis, Minnesota

ACO Name and Location Allina Health Minneapolis, Minnesota ACO Name and Location Allina Health Minneapolis, Minnesota ACO Primary Contact Patrick Flesher Director, Payer Contracting & Pioneer ACO Program Email: Patrick.Flesher@allina.com Phone: 612-262-4865 Composition

More information

Annual Quality Assessment Performance Improvement Program Evaluation

Annual Quality Assessment Performance Improvement Program Evaluation Annual Quality Assessment Performance Improvement Program Evaluation 2012 Quality Improvement Annual Evaluation for 2012 Table of Contents INTRODUCTION...4 PROGRAM OVERVIEW...4 QUALITY ASSESSMENT AND PERFORMANCE

More information

Accountable Care Organizations: Notice of Proposed Rulemaking

Accountable Care Organizations: Notice of Proposed Rulemaking Accountable Care Organizations: Notice of Proposed Rulemaking Presentation by: Pam Silberman, JD, DrPH North Carolina Institute of Medicine April 15, 2011 1 Accountable Care Organizations (ACOs) An ACO

More information

Prevents future health problems. You receive these services without having any specific symptoms.

Prevents future health problems. You receive these services without having any specific symptoms. Preventive Care To help you live the healthiest life possible, we offer free preventive services for most Network Health members. Please refer to your member materials, which you received when you enrolled

More information

ACO Program: Quality Reporting Requirements. Jennifer Faerberg Mary Wheatley April 28, 2011

ACO Program: Quality Reporting Requirements. Jennifer Faerberg Mary Wheatley April 28, 2011 ACO Program: Quality Reporting Requirements Jennifer Faerberg Mary Wheatley April 28, 2011 Agenda for Today s Call Overview Quality Reporting Requirements Benchmarks/Thresholds Scoring Model Scoring Methodology

More information

Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year

Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2015 benchmarks for ACO-9 and ACO-10 quality

More information

Medicaid Managed Care EQRO and MLTSS Quality. April 3, 2014 IPRO State of Nebraska EQRO

Medicaid Managed Care EQRO and MLTSS Quality. April 3, 2014 IPRO State of Nebraska EQRO Medicaid Managed Care EQRO and MLTSS Quality April 3, 2014 IPRO State of Nebraska EQRO IPRO provides a full spectrum of healthcare assessment and improvement services that foster the efficient use of resources

More information

Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute

Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute Session 16: C.1. Performance Reports National Reports Some reports present information on a category of providers

More information

Small Physician Groups Aim High

Small Physician Groups Aim High Small Physician Groups Aim High Arch Health Partners A medical foundation in San Diego formed by Palomar Health and PIMG, a 20 year old multispecialty medical group formerly known as Centre for Health

More information

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 1. BMI - Documented in patients medical record on an annual basis. Screen for obesity and offer intensive counseling and behavioral

More information

ABELMed EHR-EMR/PM version 12, an ONC HIT 2014 Edition Complete EHR, has been certified for the following 42 clinical quality measures (CQMs).

ABELMed EHR-EMR/PM version 12, an ONC HIT 2014 Edition Complete EHR, has been certified for the following 42 clinical quality measures (CQMs). ABELMed EHR-EMR/PM version 12, an ONC HIT 2014 Edition Complete EHR, has been certified for the following 42 clinical quality measures (CQMs). The information contained in this document is also available

More information

Welcome to Magellan Complete Care

Welcome to Magellan Complete Care Magellan Complete Care of Florida Provider Newsletter Welcome to Magellan Complete Care On behalf of Magellan Complete Care of Florida, thank you for your continued support and collaboration. As the only

More information

HMO Performance Report

HMO Performance Report NJ FamilyCare / Medicaid HMO Performance Report A Report on Utilization, Quality, and Member Satisfaction Delivered Under the New Jersey Medicaid and CHIP Managed Care Program 2011 Prepared by the Department

More information

2015 PROVIDER TOOLKIT Understanding the Centers for Medicare and Medicaid (CMS) Stars Rating System

2015 PROVIDER TOOLKIT Understanding the Centers for Medicare and Medicaid (CMS) Stars Rating System Understanding the Centers for Medicare and Medicaid (CMS) Stars Rating System 7990 IH 10 West, Suite 300 San Antonio, TX 78230 What is CMS Quality Star Ratings program? CMS evaluates health insurance plans

More information

MARYLAND HEALTH CONNECTION

MARYLAND HEALTH CONNECTION MARYLAND HEALTH CONNECTION Quality Report 2013 Measuring the Quality and Performance of Qualified Health Plans available through the Maryland Health Connection Board members Joshua Sharfstein, MD Chairman

More information