Drugs to identify members on ace inhibitors or arbs cdcl. We created the hedis quick reference guide to help you increase your practices hedis rates. About the hedis 2016 measures reporting year 2015 hedis healthcare effectiveness data and information set is a set of performance measures developed by the national committee for quality assurance ncqa. Hedis quick reference guide updated to reflect ncqa hedis 2016 technical specifications mhs health wisconsin strives to provide quality healthcare to. That is why we publish what we learn from hedis in many forums and formats hedis users group hug. No license is required for noncommercial uses of the measures to report quality data under the marketplace quality rating system qrs. Colorectal cancer screening col we are committed to working with you to improve the quality of care and health outcomes for our members, your patients. Hedis quick reference guide updated to reflect ncqa hedis 2018 technical specifications what is hedis. Hedis 2017 guidelines 4 wellchild visits in the third, fourth, fifth and sixth years of age hedis 2017 guidelines members who are 3 to 6 years of age as of december 31, 2016 and who receive one or more wellchild visits between january 1, 2016 and december 31, 2016. Use of appropriate medications for people with asthma asm.
Hedis measure memberdescription documentation requirements codes. Your 2016 guide to key hedis measures keystone first. The quality improvement provider resource guide and toolkit is designed to provide health plan network primary care providers pcp with information on quality measures and what they mean to the health plan. Patients 1821 must also have bmi percentile documented. It also shows the 50th percentile of hedis results for medicaid in the u. Providers play a critical role in the outcome of hedis measures. For more information on how to code visits, see the following posters. This document details some of the key features of the hedis. Some measures, such as cervical cancer screening, look for services performed up to 5 years prior to the reporting year. Reporting hedis rates hedis measures evaluate the previous years clinical data. Proportion of days covered by medications pdc and highrisk medication hrm.
Anyone desiring to use or reproduce the materials, subject to. Measure abbreviation pip measure title hedis measure title. Hedis is the gold standard for measuring quality health care performance, and is part of the ncqa accreditation process. Hedis measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes.
Ncqa holds a in these materials and may rescind or alter these materials at any time. How payers can improve hedis quality measure performance. Administrative measures report rates for the entire eligible population e. Hedis ataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards. Measure short description and title as used in sfhps practice improvement program pip ncqa hedis measure abbreviation some measures have multiple services required labeled here as indicators industry standard alphanumeric representation of service. The payer adopted a cloudbased data analytics system to build a longitudinal disease registry, which includes six disease brackets, clinical measures, pay. Users of the hedis measures and specifcations shall not have the right to alter, enhance or otherwise modify the hedis measures and specifcations, and shall not disassemble, recompile or reverse engineer the hedis measures and specifcations. Magnolia health strives to provide quality healthcare to our membership as measured through hedis quality metrics. Hedis wellchild documentation hedis provider manual new. Members ages 4075 with at least one statin prescription filled during the measurement year. The 2017 bcbsil hmo hedis report, which is based on 2016 data using hedis 2017 specifications, includes measures across domains of care that reflect effectiveness of care and accessavailability of care and utilization.
Hedis gives purchasers, physicians and consumers standardized information. Hedis measures through a committee represented by purchasers, consumers, health plans, healthcare providers, and policymakers. A guide to understanding medicaid measure compliance. The healthcare effectiveness data and information set hedis consists of a set of performance measures developed by the national committee for quality assurance ncqa, and is used by more than 90 percent of american health plans to compare how well a plan performs in these areas. Therere some new and revised measures in hedis this year. The hedis measures and specifcations were developed by and are owned by ncqa. Standardized rates in this report are based on four age brackets, three race categories black, white, other, hispanic ethnicity, and marital status as reported on the vital. Quality measures desktop reference for medicaid providers. Hedis healthcare effectiveness data and information set is one tool we use to measure many aspects of performance.
Pcp hedis quick reference guide for primary care providers hedis measure measure requirements recommended services adult bmi assessment aba hybrid measure patients 18 to 74 years old have a documented weight and calculated bmi in 2015 or 2016 bmi z68. Listed codes are examples acceptable for hedis 919 adult bmi assessment. Hedis is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. Commercial use is defined as the sale, license, or distribution of the. Hedis measures and claims not coded according to hedis guidelines andor incomplete medical record documentation represent a missed opportunity to accurately reflect quality of care. Hedis measures summary 2018 horizon blue cross blue. Quality measures desktop reference for medicaid providers please note. The measures were developed by the national committee for quality assurance ncqa and are updated annually. Members with dentalonly, and catastrophiconly products are excluded when determining eligible membership for qarr. The 2016 hedis measures for qrs contained in this document are ed by ncqa and are reprinted herein with the permission of ncqa. Hedis 2017 is published across a number of volumes and includes 91 measures. Adult bmi assessment aba weight assessment and counseling for nutrition and physical activity for childrenadolescents wcc childhood immunization status cis. Ncqa has expanded the size and scope of hedis to include measures for physicians, ppos and other organizations. Users of the hedis measures and specifcations shall not have the right to alter, enhance or otherwise modify the hedis measures and specifcations, and shall not.
The healthcare effectiveness data and information set hedis is a tool that helps health plans measure the quality of care their members receive. Documentation with the most recent hba1c test performed during 2016. Measure and record height, weight, and bmi at every office visit for all patients 1874. Aim to enhance quality of care and reduce costs by meeting performance measures and three criteria. Department of financial services dfs prior to 2016 must report all qarr measures. These two rates come from the ncqas quality compass database, and indicates that the topperforming 10% and 25%, respectively, of all medicaid managed care plans nationwide had measure rates equal to, or better than, the listed rate. Hedis is a set of standardized measures that specifies how organizations collect, audit and report performance information across the most pressing clinical areas, as well. Monitoring patients on persistent medications mpm hybrid measures report rates for a sample of the eligible population e. Medication reconciliation discharge in previous years was reported at only the snp benefit packagelevel. Hedisataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards. The methodology delineated in the most recent hedis comprehensive diabetes care measure should be used. Ncqa screens, trains and certifies organizations that collect or audit data for health plans and providers hedis reports and research. Hedis is a performance measurement tool that is coordinated and administered by ncqa and used by.
Hedis was developed and is maintained on an annual. Measure data element abhk final hedis 2016 rate ncqa 2015 hedis 50th. Key ways blue cross blue shield raises its hedis scores. Hedis 2016 was the first measurement year the measure was collected at the ma contractlevel. In most cases, the higher the number, the better the results.
One way quality of care can be verified is through industry st andard performance measures. Percent members 564 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year. Buckeye uses hedis data to identify areas for improvement and monitor progress. To make the most of yo ur office visits towards meeting hedis measures, please document the following criteria as applicable. Healthcare effectiveness data and information set hedis. Contact your provider account executive for more information, including inoffice education on the 2016 hedis measures. For example, most hedis rates reported in 2016 are based on clinical services performed in 2015.
The calculation schedule for the hedis measures is a projected schedule as of march 2018 and may be subject to change. Hedis measuresa doctor providersierra health and life. Accountable health care requires both measurement and transparency. The healthcare effectiveness data and information set hedis is a set of standardized performance measures developed by the national committee for quality assurance ncqa to objectively measure, report, and compare quality across health. May 26, 2016 the healthcare effectiveness data and information set hedis is used by more than 90 percent of all health plans situated around.