It also shows the overall 2015 statewide average hedis results for medicaid. Ncqa released the first healthcare effectiveness data and information set hedis in 1993 and its become the national standard for health plan performance reporting. My 2016 value based p4p hedis 201 7 pharmacy table c rosswalk. Molina healthcare strives to be better than 90 percent of all medicaid plans. More than 90 percent of the nations health care organizations report their health plans performance annually using hedis standards. Hedis is a retrospective process hedis 2017 calendar year 2016 data hedis is a yearround effort. The methodology delineated in the most recent hedis comprehensive diabetes care measure should be used. The 2016 hedis measures for qrs contained in this document are ed by ncqa and are reprinted herein with the permission of ncqa. Those members with a diagnosis of major depression and were treated with.
For hedis 2016, dhmh required healthchoice managed care organizations to report the complete. Introduction 15 hedis 2016, volume 6 ncqa ncqa notifies maos that they are required to participate in the survey and provides them with guidelines for contracting with cmsapproved hos survey vendors. 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. The healthcare effectiveness data and information set hedis is a tool that helps health plans measure the quality of care their members receive. Magnolia health strives to provide quality healthcare to our membership as measured through hedis quality metrics. Commercial use is defined as the sale, license, or distribution of the. Healthcare effectiveness data and information set hedis. This year, the new hedis technical specifications include seven new measures, changes to four existing measures and two crosscutting topics that address issues across multiple measures. Masshealth hedis 2016 measures masshealth selected 14 measures for the hedis 2016 report. Hedisataglance is a reference guide designed to help your practice. Care is an national committee for quality assurance ncqa accredited health plan. Some measures, such as cervical cancer screening, look for services performed up to 5 years prior to the reporting year. The 2016 hedis measures for qrs contained in this document are.
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. The 2016 measures reflect performance for the 2015 calendar year. Hedis measures through a committee represented by purchasers, consumers, health plans, healthcare providers, and policymakers. Ncqa health plan accreditation builds upon more than 25 years of experience to provide a current, rigorous and comprehensive framework for essential quality improvement and measurement. Hedis measure set for services rendered in calendar year. The following table shows our aetna better health of texas hedis results from 2015 to 2016.
Reporting hedis rates hedis measures evaluate the previous years clinical data. Aetna life insurance company arizona hedis 2016 quality. Use population health management software to identify patients in need of preventive health services. Hedis includes measures for physicians, ppos and other organizations. Measure and record height, weight, and bmi at every office visit for all patients 1874. Hedis 2017 is published across a number of volumes and includes 91 measures. Buckeye uses hedis data to identify areas for improvement and monitor progress. Hedis hedis is a set of standardized measures used to evaluate performance in the health care industry.
Hedis is a set of standardized measures that specifies how organizations collect, audit and report performance. Hedis is a set of standardized measures that specifies how. Please refer to for hedis program measures and guidelines as well as. Audited hedis results are reported for hmo illinois and blue advantage hmo sm combined. Members ages 4075 with at least one statin prescription filled during the measurement year. Statewide executive summary hedis 2016 maryland medicaid. We created the hedis quick reference guide to help you increase your practices hedis rates. 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. Documentation tips sample codes used antidepressant medication management. 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. Michigan quality improvement consortium detailed measurement. Hedis quick reference guide updated to reflect ncqa hedis 2016 technical specifications mhs health wisconsin strives to provide quality healthcare to. Aim to enhance quality of care and reduce costs by meeting performance measures and three criteria.
Ncqa has expanded the size and scope of hedis to include measures for physicians, ppos and other organizations. Hedis is a registered trade mark of the national committee for quality assurance ncqa. Hedis wellchild documentation hedis provider manual new. Manage your healthcare outcomes aapc knowledge center. Hedis measure memberdescription documentation requirements codes. Hedis measuresa doctor providersierra health and life. Every autumn, the state of health care quality report summarizes performance from the previous calendar year for key hedis and cahps measures. Snps report a subset of the full ma hedis measures set, so this report compares only the measures that are commonly report at the snp benefitpackage level and the ma contractlevel. Reimbursement for these services is in accordance with the terms and conditions of your provider agreement. Preventive care, chronic disease management, perinatal care, and behavioral health care. Hedis the healthcare effectiveness data and information set is the gold standard in health care performance measurement, used by more than 90 percent of the nations health plans and many leading employers and regulators.
Your 2016 guide to key hedis measures keystone first. Health care providers play a key role in guiding children and adolescents toward healthy behaviors. Hedis was developed and is maintained on an annual. For example, most hedis rates reported in 2016 are based on clinical services performed in 2015.
Listed codes are examples acceptable for hedis 919 adult bmi assessment. Ncqa, through a subcontract with rti international, generates hos samples and forwards them to survey vendors. Patients 1821 must also have bmi percentile documented. The previous calendar year is the standard measurement year for 2016 hedis for. Contact your provider account executive for more information, including inoffice education on the 2016 hedis measures. Documentation with the most recent hba1c test performed during 2016. Therere some new and revised measures in hedis this year. Providers play a critical role in the outcome of hedis measures. Twelve of these 14 measures assess the quality of health care in four domains. This document details some of the key features of the hedis. Hedis measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. 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. Last updated july 6, 2016 page 5 ncqa natl percentiles shown on the medicaidmarketplaceduals hedis profile only the 25th, 50th, 75th and 90th national percentiles are included for comparison purposes.
Hedis healthcare effectiveness data and information set is one tool we use to measure many aspects of performance. Staying ahead is the best way to keep from falling behind, especially when it comes to the hedis submission process. No license is required for noncommercial uses of the measures to report quality data under the marketplace quality rating system qrs. The measures with the highest and lowest hedis 2016 rates were. Annual hedis calendar jan may clinical quality staff initiates medical record requests and collection from our providers. Reporting requirement guidelines table 1 lists, by product, the nysspecific and hedis 2017 measures required for submission. Statin therapy for persons with diabetes retired hedis 2016.
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. 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. Hedisataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards. Hedis measures help guide the care of pediatric members. Onehalf of the quality measures selected six out of the twelve are in the. With your help, aetna better health of texas has experienced an. For more information on how to code visits, see the following posters. Hedis consists of 80 measures across five domains of care that address important health issues.
Hedis measures summary 2018 eligible populations, administrative codes and medical record documentation one of the most widely used tools for improving quality and measuring health care plan performance in the united states is the healthcare effectiveness data and information set hedis. It is the only program in the industry that bases results on clinical performance and consumer experience hedis and cahps. Members with dentalonly, and catastrophiconly products are excluded when determining eligible membership for qarr. Visitors to this page often check hedis faqs, qrs faqs, or ask a question through myncqa.
That makes hedis one of health cares most widely used performance improvement tools. Department of financial services dfs prior to 2016 must report all qarr measures. Hedis gives purchasers, physicians and consumers standardized information. My 2016 value based p4p hedis 201 7 pharmacy table c. Hedis ataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards. The ma program performance was higher than the snp program performance for 22 of 28 measures in 2016, with significant differences for 14 of these.
Exclusions for hba1c control 2016 hedis ataglance l. Ncqa established healthcare effectiveness data and information set hedis measures specifically for snps. Hedis healthcare effectiveness data and information set is a set of standardized performance measures developed by the national committee for quality assurance ncqa to objectively measure, report, and compare quality across health plans. The information provided is in this document is for 2016 hedis period and is current at. To make the most of yo ur office visits towards meeting hedis measures, please document the following criteria as applicable. Hedis is the gold standard for measuring quality health care performance, and is part of the ncqa accreditation process. Centennial care reporting instruction audited hedis. Using the correct medical record documentation will ensure your efforts are acknowledged. June results are reported to ncqa july oct ncqa releases quality compass results nationwide july commercial edition sepoct medicaid and medicare editions each year ncqa sets a hard deadline in may. Ensuring hediscompliant provider portal features preventive.
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