Healthcare Effectiveness Data and Information Set (HEDIS ... HE… · Healthcare Effectiveness Data...

Healthcare Effectiveness Data and Information Set (HEDIS)

Report Year 2019 Measurement Year 2018

Summary of Performance

Partnership HealthPlan of California Report Year 2019; Measurement Year 2018

Table of Contents

Plan-wide & Regional Composite Score…………………………………………………………………………. Pg. 3 Summary of Performance below MPL…………………………………………………………………………….. Pg. 4 Performance by Region………………………………………………………………………………………………….. Pgs. 5-8

Summary of Performance by Region…………………………………………………………………… Pg. 5 Performance Relative to National Medicaid Benchmarks……………………………………. Pg. 6 Percentage Difference from Prior Year………………………………………………………………… Pg. 7 Percentile Ranking Change from Prior Year………………………………………………………… Pg. 8

Performance by County………………………………………………………………………………………………….. Pgs. 9-13 Summary of Performance by County…………………………………………………………………… Pg. 9 Northeast Region: Modoc, Trinity, Siskiyou, Shasta, and Lassen Counties…………... Pg. 10 Northwest Region: Del Norte and Humboldt Counties……………………………………….. Pg. 11 Southeast Region: Solano, Yolo, and Napa Counties…………………………………………... Pg. 12 Southwest Region: Lake, Marin, Mendocino, and Sonoma Counties…………………... Pg. 13

Summary of Measures in the PCP QIP included in the HEDIS 2019 Measurement Set…... Pg. 14 Measurement Set Descriptions………………………………………………………………………………………. Pgs. 15-17 Performance Improvement Summary 18-19…………………………………………………………………... Pgs. 18-21

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.


NCQA’s Notice of Copyright and Disclaimers

The source for certain health plan measure rates and benchmark (averages and percentiles) data (“the Data”) is Quality Compass® [2018] and is used with the permission of the National Committee for Quality Assurance (“NCQA”). Any analysis, interpretation, or conclusion based on the Data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA.

The Data is comprised of audited performance rates and associated benchmarks for Healthcare Effectiveness Data and Information Set measures (“HEDIS®”) and HEDIS CAHPS® survey measure results. HEDIS measures and specifications were developed by and are owned by NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or clinician that uses or reports performance measures or any data or rates calculated using HEDIS measures and specifications and NCQA has no liability to anyone who relies on such measures or specifications.

NCQA holds a copyright in Quality Compass and the Data and can rescind or alter the Data at any time. The Data may not be modified by anyone other than NCQA. Anyone desiring to use or reproduce the Data without modification for an internal, non-commercial purpose may do so without obtaining any approval from NCQA. All other uses, including a commercial use and/or external reproduction, distribution, publication must be approved by NCQA and are subject to a license at the discretion of NCQA. ©2018 National Committee for Quality Assurance, all rights reserved.

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

DWilliamson

Sticky Note

Completed set by DWilliamson

SOUTHEAST SOUTHWEST NORTHEAST NORTHWEST

2018 2019 2018 2019 2018 2019 2018 20190%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

78.95% 78.42%

68.42%

73.16%

45.79%

51.05%49.47%

45.79%

RY2018Avg:61%

RY2019Avg:62%

RY2018Avg:61%

RY2019Avg:62%

RY2018Avg:61%

RY2019Avg:62%

RY2018 Avg: 61%

RY2019 Avg: 62%

RY2018 - Total Points Earned: 461 Points out of 760 Total Points (19measures included)

Ø Measures excluded due to not being held accountable for HEDIS RY 2018 &2019: AMB, CAP, and DSFØ Measures excluded due to not being held accountable for HEDIS RY 2019:PCR (ACR), CCS, CBPØ Measures included: MPM (2 indicators), AAB, BCS, CIS-3, CDC (6 indicators),IMA-2, PPC (2 indicators), AMR, LBP, WCC (2 indicators) & W34

RY2019 - Total Points Earned: 472 Points out of 760 Total Points (19measures included)

Ø Measures excluded due to not being held accountable for HEDIS RY2019: AMB, CAP, CCS, CBP, DSF, and PCRØ Measures included: MPM (2 indicators), AAB, BCS, CIS-3, CDC (6indicators), IMA-2, PPC (2 indicators), AMR, LBP, WCC (2 indicators) & W34Ø ACR (non-NCQA) measure was replaced with the PCR (NCQA) measure inRY2019

Composite HEDIS Performance by Reporting YearScore = Points Earned/ Possible Points. Points are awarded per measure based on percentile ranking: 1 point for <10th percentile, 2 forthe 10th, 3 for the 17.5, 4 for the 25th, 5 for the 37.5, 6 for the 50th, 7 for the 62.5, 8 for the 75th, 9 for the 82.5, and 10 for the 90th

3


Summary of Performance below MPL relative to PY for measures in which DHCS holds MCP’s accountable for

Region Measure RY2018 RY2019Northeast Annual Monitoring for Patients on

Persistent Medications (MPM)- ACE or ARB

<MPL <MPL

Annual Monitoring for Patients on Persistent Medications (MPM)- Diuretics <MPL

Asthma Medication Ratio (AMR) <MPL <MPL Breast Cancer Screening (BCS) <MPL Childhood Immunization Status (CIS) – Combo 3 <MPL <MPL

Immunizations for Adolescents (IMA) – Combo 2

<MPL <MPL

Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34)

<MPL

Northwest Annual Monitoring for Patients on Persistent Medications (MPM)- ACE or ARB

<MPL <MPL

Annual Monitoring for Patients on Persistent Medications (MPM)- Diuretics <MPL

Asthma Medication Ratio (AMR) <MPL <MPL

Breast Cancer Screening (BCS) <MPL <MPL Cervical Cancer Screenings (CCS) <MPL Childhood Immunization Status (CIS) – Combo 3 <MPL <MPL

Comprehensive Diabetes Care (CDC) – Eye Exam <MPL

Comprehensive Diabetes Care (CDC) – Medical Attention for Nephropathy

<MPL <MPL

IMA- Combination 2 Immunizations <MPL Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) <MPL <MPL

Southwest Asthma Medication Ratio (AMR) <MPL

Childhood Immunization Status (CIS) – Combo 3

<MPL

Comprehensive Diabetes Care (CDC) – Medical Attention for Nephropathy

<MPL <MPL

Total <MPL 14 17The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

4

YOLO

TRINITY

SONOMASOLANO

SISKIYOU

SHASTA

MODOC

MENDOCINO

MARIN

LASSEN

LAKE

HUMBOLDT

DEL NORTE

NAPA

Partnership HealthPlan of CaliforniaHealthcare Effectiveness Data and Information Set

(HEDIS®)Report Year 2019; Measurement Year 2018Summary of Performance by Region

ChoosePer.. NORTHEAST NORTHWEST SOUTHEAST SOUTHWEST

90th (HPL)

75th

50th

25th

<25th (MPL)

7

2

7

5 10

1

3

4

3

11

5

4

1

6

4

7

2

2

Distribution of Measures by Percentile Ranking

Measures NORTHWEST SOUTHEAST SOUTHWEST

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)*

Cervical Cancer Screening (CCS)

Comprehensive Diabetes Care (CDC) - Eye Exam

Comprehensive Diabetes Care (CDC) - Medical Attention for Nephropathy

Immunizations for Adolescents (IMA) - Combo 2

Prenatal and Postpartum Care (PPC) - Postpartum Care

Prenatal and Postpartum Care (PPC) - Timeliness of Prenatal Care

Use of Imaging Studies for Low Back Pain (LBP)*

Measures At or Above the High Performance Level (HPL) - 90th Percentile

Measures Below the Minimum Performance Level (MPL) - 25th Percentile

Measures NORTHEAST NORTHWEST SOUTHWEST

Annual Monitoring for Patients on Persistent Medications (MPM) - ACE or ARB*

Annual Monitoring for Patients on Persistent Medications (MPM) - Diuretics*

Asthma Medication Ratio (AMR) - Total 5 to 64 Ratios > 50%*

Breast Cancer Screening (BCS)*


Childhood Immunization Status (CIS) - Combo 3


Comprehensive Diabetes Care (CDC) - Medical Attention for Nephropathy


Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life (W34)

*- Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybridmeasures). NOTES: Report excludes measures reported to DHCS where DHCS does not hold Managed Care plans accountable for meeting specific performance targets(i.e. Plan-wide All Cause Readmission, Ambulatory Care, Children & Adolescents Access to Primary Care Practitioners, Screening for Clinical Depression). - The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

5

DWilliamson

Sticky Note

Completed set by DWilliamson

Measures NORTHEAST NORTHWEST SOUTHEAST SOUTHWEST

Annual Monitoring for Patients on PersistentMedications (MPM) - ACE or ARB*

Annual Monitoring for Patients on PersistentMedications (MPM) - Diuretics*

Asthma Medication Ratio (AMR) - Total 5 to 64Ratios > 50%*

Avoidance of Antibiotic Treatment in Adults withAcute Bronchitis (AAB)*




Comprehensive Diabetes Care (CDC) - BloodPressure Control (<140/90)


Comprehensive Diabetes Care (CDC) - HbA1cControl (<8%)

Comprehensive Diabetes Care (CDC) - HbA1c PoorControl (>9%)

Comprehensive Diabetes Care (CDC) - HbA1cTesting

Comprehensive Diabetes Care (CDC) - MedicalAttention for Nephropathy

Controlling High Blood Pressure (CBP)


Prenatal and Postpartum Care (PPC) - PostpartumCare

Prenatal and Postpartum Care (PPC) - Timeliness ofPrenatal Care


Weight Assessment and Counseling for Nutrition &Physical Activity (WCC) - Counseling for Nutrition

Weight Assessment and Counseling for Nutrition &Physical Activity (WCC) - Counseling for PhysicalActivity

Well-Child Visits in the 3rd, 4th, 5th, and 6th Yearsof Life (W34)

74.24%

76.84%

81.92%

91.16%

79.57%

39.42%

59.85%

87.10%

90.02%

33.82%

54.74%

70.80%

72.02%

68.86%

71.46%

68.37%

72.51%

76.90%

86.13%

76.16%

46.96%

63.50%

94.79%

91.81%

30.77%

54.34%

63.03%

67.00%

73.48%

65.77%

63.26%

64.58%

64.06%

87.35%

69.59%

25.55%

56.20%

88.08%

89.78%

31.14%

53.53%

45.26%

67.40%

53.53%

49.88%

62.02%

61.80%

63.50%

84.43%

59.61%

17.52%

65.94%

88.56%

90.51%

32.12%

57.91%

65.94%

75.18%

52.55%

55.28%

83.25%

56.30%

46.89%

55.00%

89.82%

88.88%

82.62%

60.33%

46.81%

64.65%

90.41%

90.88%

81.98%

47.75%

30.29%

50.20%

84.36%

83.95%

76.34%

53.32%

36.68%

50.90%

87.60%

85.01%

Regional Performance

HEDIS Regional Performance Report Year 2019; Measurement Year 2018

Performance Relative to Quality Compass® Medicaid Benchmarks

● Above HPL (high performance level, based on NCQA’s Quality Compass Medicaid 90th percentile)● Below MPL (minimum performance level,based on NCQA’s Quality Compass Medicaid 25th percentile)

25TH 50TH 75TH 90TH

83.70%

78.35%

83.45%

79.88%

90.75%

73.97%

46.72%

71.04%

93.43%

92.70%

29.68%

59.49%

68.61%

77.50%

79.56%

70.68%

68.94%

44.64%

71.93%

92.90%

92.87%

79.33%

71.29%

77.91%

75.96%

87.06%

69.34%

37.71%

65.78%

92.05%

90.45%

33.09%

55.47%

64.23%

70.76%

74.70%

66.01%

64.12%

37.36%

67.03%

90.65%

90.62%

73.89%

63.50%

69.57%

71.71%

83.21%

65.21%

31.87%

58.64%

90.51%

87.83%

38.20%

51.34%

57.88%

63.02%

70.80%

60.10%

58.04%

31.97%

62.28%

88.31%

88.20%

67.15%

52.31%

59.85%

67.19%

76.89%

59.61%

26.28%

49.15%

88.56%

84.93%

47.20%

44.44%

50.85%

56.20%

65.45%

54.26%

51.78%

27.63%

56.85%

86.06%

85.97%

National Medicaid Benchmarks

* - Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybridmeasures). - Quality Compass® is a registered trademark of NCQA.

6


Percentage Difference from Prior Year

● Measures that improved more than 5% from prior year● Measures that declined more than 5% from prior year

Measures NORTHEAST NORTHWEST SOUTHEAST SOUTHWEST



Asthma Medication Ratio (AMR) - Total 5 to 64 Ratios> 50%*





Comprehensive Diabetes Care (CDC) - Blood PressureControl (<140/90)


Comprehensive Diabetes Care (CDC) - HbA1c Control(<8%)


Comprehensive Diabetes Care (CDC) - HbA1c Testing









Well-Child Visits in the 3rd, 4th, 5th, and 6th Years ofLife (W34)

-9.79%

5.93%

4.52%

4.15%

5.84%

2.43%

-1.99%

0.97%

1.22%

-4.14%

2.68%

10.46%

2.68%

4.44%

13.68%

-6.63%

-1.22%

-1.01%

2.25%

8.39%

1.46%

1.77%

1.39%

-1.34%

-1.02%

-2.87%

0.44%

-1.95%

0.27%

-0.63%

-0.19%

-1.10%

-4.33%

7.03%

9.48%

-2.43%

-1.70%

0.97%

2.19%

-2.92%

0.97%

-2.68%

5.60%

-1.92%

-5.11%

-5.27%

3.89%

0.97%

4.84%

-1.10%

2.92%

0.67%

-1.46%

3.41%

-6.57%

7.54%

10.22%

6.81%

-5.47%

-0.33%

0.30%

3.45%

2.43%

-2.36%

2.80%

2.20%

0.33%

3.37%

5.61%

-0.76%

1.64%

1.57%

1.65%

0.44%

-4.58%

-0.24%

-1.74%

-0.51%

0.68%

1.79%

0.76%

-1.12%

3.09%

1.21%


* - Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybridmeasures).CDC-HbA1c Poor Control (>9) – Decrease indicates performance improvement

7


Percentile Ranking Change from Prior Year

● Measure percentile ranking improved from Prior Year● Measure percentile ranking decreased from Prior Year

Measures

NORTHEAST

2018 2019

NORTHWEST

2018 2019

SOUTHEAST

2018 2019

SOUTHWEST

2018 2019



Asthma Medication Ratio (AMR) - Total 5 to 64Ratios > 50%*





Comprehensive Diabetes Care (CDC) - BloodPressure Control (<140/90)


Comprehensive Diabetes Care (CDC) - HbA1cControl (<8%)


Comprehensive Diabetes Care (CDC) - HbA1cTesting









Well-Child Visits in the 3rd, 4th, 5th, and 6th Yearsof Life (W34)

<25th

25th

25th

50th

25th

<25th

75th

25th

75th

75th

75th

75th

75th

<25th

25th

25th

25th

25th

25th

25th

<25th

75th

25th

50th

50th

50th

50th

50th

<25th

25th

75th

25th

50th

<25th

25th

<25th

75th

<25th

75th

<25th

<25th

<25th

<25th

50th

25th

75th

75th

<25th

25th

<25th

50th

75th

50th

<25th

50th

<25th

<25th

<25th

50th

50th

25th

25th

75th

50th

<25th

50th

75th

50th

25th

50th

<25th

25th

90th

<25th

25th

<25th

<25th

<25th

90th

<25th

75th

<25th

25th

<25th

25th

75th

50th

50th

90th

90th

50th

90th

75th

75th

50th

50th

50th

50th

50th

50th

75th

75th

50th

50th

90th

50th

90th

90th

75th

75th

50th

75th

50th

75th

90th

50th

90th

50th

50th

75th

90th

25th

90th

50th

50th

50th

50th

75th

75th

90th

90th

75th

50th

<25th

50th

50th

50th

90th

75th

25th

90th

90th

75th

75th

50th

90th

90th

50th

<25th

50th

50th

50th

50th

75th

<25th

25th

90th

25th

90th

<25th

50th

50th

90th

25th

90th

25th

25th

25th


*- Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybridmeasures).

8

Partnership HealthPlan of CaliforniaHealthcare Effectiveness Data and Information Set (HEDIS)

YOLO

SONOMA

SOLANO

MENDOCINO

MARIN

LAKE

HUMBOLDT TRINITY

SISKIYOU

SHASTA

NAPA

MODOC

LASSEN

DEL NORTE

Sub Region County <25th (MPL) 25th 50th 75th 90th (HPL)

NORTHEAST SHASTA

SISKIYOU

LASSEN

TRINITY

MODOC

NORTHWEST HUMBOLDT

DEL NORTE

SOUTHEAST SOLANO

YOLO

NAPA

SOUTHWEST SONOMA

MENDOCINO

MARIN

LAKE

17

14

6

7

9

10

6

1

1

5

2

6

5

6

4

2

3

4

6

2

6

2

2

1

4

6

3

2

4

1

2

4

7

8

5

8

6

7

4

5

7

3

2

1

7

4

3

4

3

2

6

1

1

2

1

1

11

3

6

9

4

8

2

Distribution of Percentile Rankings by County

NOTES: Report excludes measures reported to DHCS where DHCS does not hold Managed Care plans accountable for meeting specific performance targets (i.e. Plan-wide AllCause Readmission, Ambulatory Care, Children & Adolescents Access to Primary Care Practitioners, Screening for Clinical Depression).

Report Year 2019; Measurement Year 2018

Summary of Performance by County

9

25TH 50TH 75TH 90TH

83.70%

78.35%

83.45%

79.88%

90.75%

73.97%

46.72%

71.04%

93.43%

92.70%

29.68%

59.49%

68.61%

77.50%

79.56%

70.68%

68.94%

44.64%

71.93%

92.90%

92.87%

79.33%

71.29%

77.91%

75.96%

87.06%

69.34%

37.71%

65.78%

92.05%

90.45%

33.09%

55.47%

64.23%

70.76%

74.70%

66.01%

64.12%

37.36%

67.03%

90.65%

90.62%

73.89%

63.50%

69.57%

71.71%

83.21%

65.21%

31.87%

58.64%

90.51%

87.83%

38.20%

51.34%

57.88%

63.02%

70.80%

60.10%

58.04%

31.97%

62.28%

88.31%

88.20%

67.15%

52.31%

59.85%

67.19%

76.89%

59.61%

26.28%

49.15%

88.56%

84.93%

47.20%

44.44%

50.85%

56.20%

65.45%

54.26%

51.78%

27.63%

56.85%

86.06%

85.97%


Measures MODOC TRINITY SISKIYOU SHASTA LASSEN

Annual Monitoring for Patients on Persistent Medications(MPM) - ACE or ARB

Annual Monitoring for Patients on Persistent Medications(MPM) - Diuretics

Asthma Medication Ratio (AMR) - Total 5 to 64 Ratios >50%

Avoidance of Antibiotic Treatment in Adults with AcuteBronchitis (AAB)

Breast Cancer Screening (BCS)








Comprehensive Diabetes Care (CDC) - Medical Attentionfor Nephropathy





Use of Imaging Studies for Low Back Pain (LBP)


Weight Assessment and Counseling for Nutrition &Physical Activity (WCC) - Counseling for Physical Activity

Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life(W34) 50.00%

74.00%

74.00%

84.42%

88.00%

58.00%

16.00%

56.00%

88.00%

86.00%

36.00%

48.00%

62.00%

72.00%

56.00%

62.00%

41.29%

28.77%

51.39%

80.15%

80.80%

61.76%

62.55%

63.71%

79.08%

82.59%

58.52%

15.50%

66.80%

89.96%

89.96%

32.34%

57.99%

67.29%

76.21%

52.52%

55.04%

58.76%

37.50%

52.91%

89.29%

85.69%

70.15%

58.67%

62.67%

69.19%

84.29%

60.00%

25.58%

75.00%

89.74%

96.15%

28.21%

61.54%

70.51%

79.49%

52.17%

53.47%

49.17%

34.78%

48.50%

85.42%

85.53%

40.00%

32.00%

36.00%

63.33%

86.00%

58.00%

20.00%

48.00%

74.00%

82.00%

44.00%

50.00%

46.00%

48.00%

42.86%

54.00%

29.41%

46.15%

37.21%

84.00%

82.47%

78.00%

50.00%

52.00%

51.85%

91.43%

60.00%

18.75%

54.00%

88.00%

78.00%

50.00%

46.00%

42.00%

54.00%

56.25%

46.00%

47.18%

81.82%

42.31%

90.48%

84.00%

Northeast Region

HEDIS Performance by CountyReport Year 2019; Measurement Year 2018

Northeast RegionModoc, Trinity, Siskiyou, Shasta and Lassen Counties

● Above HPL (high performance level, based on NCQA’s Quality Compass Medicaid 90th percentile)● Below MPL (minimum performance level, based on NCQA’s Quality Compass Medicaid 25th percentile)

* - Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybridmeasures).

10

25TH 50TH 75TH 90TH

83.70%

78.35%

83.45%

79.88%

90.75%

73.97%

46.72%

71.04%

93.43%

92.70%

29.68%

59.49%

68.61%

77.50%

79.56%

70.68%

68.94%

44.64%

71.93%

92.90%

92.87%

79.33%

71.29%

77.91%

75.96%

87.06%

69.34%

37.71%

65.78%

92.05%

90.45%

33.09%

55.47%

64.23%

70.76%

74.70%

66.01%

64.12%

37.36%

67.03%

90.65%

90.62%

73.89%

63.50%

69.57%

71.71%

83.21%

65.21%

31.87%

58.64%

90.51%

87.83%

38.20%

51.34%

57.88%

63.02%

70.80%

60.10%

58.04%

31.97%

62.28%

88.31%

88.20%

67.15%

52.31%

59.85%

67.19%

76.89%

59.61%

26.28%

49.15%

88.56%

84.93%

47.20%

44.44%

50.85%

56.20%

65.45%

54.26%

51.78%

27.63%

56.85%

86.06%

85.97%




Northwest RegionDel Norte and Humboldt Counties

Measures DEL NORTE HUMBOLDT

Annual Monitoring for Patients on Persistent Medications (MPM) -ACE or ARB

Annual Monitoring for Patients on Persistent Medications (MPM) -Diuretics

Asthma Medication Ratio (AMR) - Total 5 to 64 Ratios > 50%

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis(AAB)




Comprehensive Diabetes Care (CDC) - Blood Pressure Control(<140/90)


Comprehensive Diabetes Care (CDC) - HbA1c Control (<8%)

Comprehensive Diabetes Care (CDC) - HbA1c Poor Control (>9%)


Comprehensive Diabetes Care (CDC) - Medical Attention forNephropathy




Prenatal and Postpartum Care (PPC) - Timeliness of Prenatal Care


Weight Assessment and Counseling for Nutrition & PhysicalActivity (WCC) - Counseling for Nutrition

Weight Assessment and Counseling for Nutrition & PhysicalActivity (WCC) - Counseling for Physical Activity

Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life (W34) 61.56%

63.16%

61.84%

82.02%

86.88%

69.97%

24.55%

57.41%

87.96%

89.81%

30.25%

53.70%

42.90%

69.14%

52.52%

52.11%

46.64%

28.81%

50.41%

84.55%

83.92%

70.51%

70.00%

72.50%

81.82%

89.71%

67.65%

29.63%

52.13%

88.51%

89.66%

34.48%

52.87%

54.02%

60.92%

58.11%

40.26%

51.88%

34.38%

49.28%

83.76%

84.01%

Northwest Region


11


Southeast RegionSolano, Yolo and Napa Counties

25TH 50TH 75TH 90TH

83.70%

78.35%

83.45%

79.88%

90.75%

73.97%

46.72%

71.04%

93.43%

92.70%

29.68%

59.49%

68.61%

77.50%

79.56%

70.68%

68.94%

44.64%

71.93%

92.90%

92.87%

79.33%

71.29%

77.91%

75.96%

87.06%

69.34%

37.71%

65.78%

92.05%

90.45%

33.09%

55.47%

64.23%

70.76%

74.70%

66.01%

64.12%

37.36%

67.03%

90.65%

90.62%

73.89%

63.50%

69.57%

71.71%

83.21%

65.21%

31.87%

58.64%

90.51%

87.83%

38.20%

51.34%

57.88%

63.02%

70.80%

60.10%

58.04%

31.97%

62.28%

88.31%

88.20%

67.15%

52.31%

59.85%

67.19%

76.89%

59.61%

26.28%

49.15%

88.56%

84.93%

47.20%

44.44%

50.85%

56.20%

65.45%

54.26%

51.78%

27.63%

56.85%

86.06%

85.97%



Measures NAPA SOLANO YOLO

Annual Monitoring for Patients on PersistentMedications (MPM) - ACE or ARB

Annual Monitoring for Patients on PersistentMedications (MPM) - Diuretics


Avoidance of Antibiotic Treatment in Adults withAcute Bronchitis (AAB)

















Well-Child Visits in the 3rd, 4th, 5th, and 6th Years ofLife (W34)

70.27%

62.22%

62.22%

79.81%

88.39%

83.04%

40.00%

62.92%

94.74%

92.98%

28.07%

59.65%

57.02%

69.30%

70.33%

63.64%

54.15%

48.45%

69.30%

88.41%

89.19%

65.04%

70.11%

77.59%

83.88%

81.51%

71.85%

45.27%

64.31%

93.80%

92.15%

31.82%

52.07%

61.98%

67.36%

75.27%

64.71%

63.76%

45.55%

60.72%

91.32%

92.18%

75.68%

89.74%

92.31%

82.76%

100.00%

80.33%

60.00%

60.38%

100.00%

88.00%

36.00%

50.00%

82.00%

60.00%

72.55%

74.00%

58.56%

50.00%

72.33%

90.02%

88.69%

Southeast Region


12

25TH 50TH 75TH 90TH

83.70%

78.35%

83.45%

79.88%

90.75%

73.97%

46.72%

71.04%

93.43%

92.70%

29.68%

59.49%

68.61%

77.50%

79.56%

70.68%

68.94%

44.64%

71.93%

92.90%

92.87%

79.33%

71.29%

77.91%

75.96%

87.06%

69.34%

37.71%

65.78%

92.05%

90.45%

33.09%

55.47%

64.23%

70.76%

74.70%

66.01%

64.12%

37.36%

67.03%

90.65%

90.62%

73.89%

63.50%

69.57%

71.71%

83.21%

65.21%

31.87%

58.64%

90.51%

87.83%

38.20%

51.34%

57.88%

63.02%

70.80%

60.10%

58.04%

31.97%

62.28%

88.31%

88.20%

67.15%

52.31%

59.85%

67.19%

76.89%

59.61%

26.28%

49.15%

88.56%

84.93%

47.20%

44.44%

50.85%

56.20%

65.45%

54.26%

51.78%

27.63%

56.85%

86.06%

85.97%

National Medicaid BenchmarksMeasures LAKE MARIN MENDOCINO SONOMA

Annual Monitoring for Patients on Persistent Medications(MPM) - ACE or ARB

Annual Monitoring for Patients on Persistent Medications(MPM) - Diuretics


Avoidance of Antibiotic Treatment in Adults with AcuteBronchitis (AAB)









Comprehensive Diabetes Care (CDC) - Medical Attentionfor Nephropathy







Weight Assessment and Counseling for Nutrition &Physical Activity (WCC) - Counseling for Physical Activity

Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life(W34)

80.49%

82.56%

85.64%

84.82%

94.01%

86.83%

51.74%

61.29%

87.79%

90.61%

33.80%

53.99%

74.18%

74.65%

70.40%

76.47%

62.78%

47.04%

57.18%

89.15%

89.28%

64.00%

65.57%

67.21%

84.38%

86.75%

74.70%

23.26%

58.82%

93.06%

93.06%

31.94%

54.17%

63.89%

66.67%

63.51%

60.26%

47.73%

53.61%

53.07%

92.48%

91.61%

80.00%

83.61%

85.25%

82.02%

86.00%

80.00%

41.18%

64.62%

88.00%

88.00%

40.00%

50.00%

78.00%

72.00%

80.56%

78.26%

57.96%

59.70%

55.19%

88.60%

86.41%

60.00%

60.00%

84.00%

78.39%

92.00%

68.00%

17.86%

53.33%

80.72%

86.75%

33.73%

57.83%

63.86%

67.47%

52.00%

59.62%

45.97%

31.58%

49.01%

90.43%

87.20%

Southwest Region


Southwest RegionLake, Marin, Mendocino and Sonoma Counties



13


Summary of Measures in the Primary Care Provider Quality Improvement Program (PCP QIP) included in the HEDIS 2019 External Accountability Set (EAS)

HEDIS Measures

2018 PCP QIP

Measures

2019 PCP QIP

Measures

Alternate Measure in PCP QIP Measures

All-Cause Readmissions (ACR)* Readmissions.

Ambulatory Care (AMBA)* Ambulatory Care Sensitive Admissions.

Annual Monitoring for Patients on Persistent Medications (MPM)- ACE or ARB*,** X

Annual Monitoring for Patients on Persistent Medications (MPM)- Diuretics*,** X

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)* Asthma Medication Ration (AMR)* .X X

Breast Cancer Screening (BCS)* X X

Cervical Cancer Screening (CCS) X X

Childhood Immunization Status (CIS) – Combo 3 X X

Comprehensive Diabetes Care (CDC) – Blood Pressure

Comprehensive Diabetes Care (CDC) – Eye Exam X X

Comprehensive Diabetes Care (CDC) – HbA1c Adequate Control (<8) X QIP measures: Good Control, HbA1c ≤9.

Comprehensive Diabetes Care (CDC) – HbA1c Poor Control (>9)* QIP measures: Good Control, HbA1c ≤9.

Comprehensive Diabetes Care (CDC) – HbA1c Testing

Comprehensive Diabetes Care (CDC) – Medical Attention for Nephropathy,*** X

Controlling High Blood Pressure (CBP) X X

Immunizations for Adolescents (IMA) – Combo 2 X X

Prenatal and Postpartum Care (PPC) – Postpartum Care Similar measure in Perinatal QIP.

Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care Similar measure in Perinatal QIP.


Weight Assessment and Counseling for Children/Adolescents (WCC) – Counseling for Physical Activity X X

Weight Assessment and Counseling for Children/Adolescents (WCC) – Counseling for Nutrition X X

Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) X X *-Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures). **- The 2 MPM measures were removed from PCP QIP in February 2019. ***-CDC-Nephropathy was removed from the PCP QIP in May 2019.

PCP QIP Measurement Set: http://www.partnershiphp.org/Providers/Quality/Pages/Introduction-to-PCP-QIP-Current-Year.aspx

14

http://www.partnershiphp.org/Providers/Quality/Pages/Introduction-to-PCP-QIP-Current-Year.aspx


Measurement Set Descriptions

HEDIS Measure Measure Indicator Measure Definition

AMR* Asthma Medication Ratio

• 5-11 Yrs• 12-18 Yrs• 19-50 Yrs• 51-64 Yrs• Total

The percentage of members ages 5-64 with persistent asthma who have a medication ratio of 0.50 or greater during 2018

AMB* Ambulatory Care

• Outpatient Visits• Emergency Department

Visits

Summarized utilization of ambulatory care for members <1 yr. through 85+yrs

AAB* Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

The percentage of adults 18-64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription

BCS* Breast Cancer Screening

The percentage of women 50–74 years of age who had one or more mammograms on or between October 1, 2016 and December 31, 2018

CAP* Children & Adolescents’ Access to Primary Care Practitioners

• 12-24 Months• 25 Months – 6 Yrs• 7-11 Yrs• 12-19 Yrs

Percentage of members 12 months - 6 years of age who had a visit with a PCP during 2018 Percentage of members 7-19 years who had a visit with a PCP during 2017 or 2018

CBP Controlling High Blood Pressure

Percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled <140/90mm Hg

CCS Cervical Cancer Screening

Percentage of women 21-64 years of age who were screened for cervical cancer: • 21-64 years: Cervical Cytology within the

last 3 years• 30-64 years: Cervical Cytology with HPV

co-testing within the last 5 years

15



CIS-3 Childhood Immunization Status – Combo 3

Percentage of children 2 years of age who receive a series of vaccines (# of injections) by their second birthday:

• DTaP: 4 • HiB: 3 • VZV: 1• IPV: 3 • PCV: 4

• Hep B: 3 • MMR: 1

CDC Comprehensive Diabetes Care

Eye Exam HbA1c Testing HbA1c Poor Control

(>9.0%) HbA1c Control (<8.0%) Medical Attn. for

Nephropathy Blood pressure control

(<140/90 mmHg)

Percentage of members 18-75 years of age with diabetes (type1 and 2) who had each of the following indicators:

IMA-2 Immunizations for Adolescents – Combination 2

Percentage of adolescents 13 years of age who had the following: • 1 Meningococcal vaccine (MCV) injection

between 11-13 years old• 1 Tetanus, diphtheria toxoids and

acellular pertussis vaccine (Tdap/Td)between 10-13 years old

• 2 HPV vaccines between 9-13 years old

LBP* Use of Imaging Studies for Low Back Pain

The percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis

16



PPC Prenatal & Postpartum Care

• Timeliness of PrenatalCare

• Postpartum Care

Percentage of deliveries of live births between November 6, 2017 and November 5, 2018. The measure assesses the following: • Timeliness of Prenatal Care: prenatal visit

in the first trimester OR within 42 days ofenrollment to PHC

• Postpartum Care: postpartum care on orbetween 21 and 56 days after delivery

MPM* Annual Monitoring for Patients on Persistent Medications

• ACE/ARBs• Diuretics

The percentage of members 18+ years of age who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during 2018 and at least one therapeutic monitoring event for the therapeutic agent in 2018

PCR* Plan-All Cause Readmissions • 18-64 Yrs

For members 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission

WCC Weight Assessment & Counseling for Nutrition & Physical Activity for Children & Adolescents

• Counseling fornutrition

• Counseling forphysical activity

Percentage of members 3-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year: • Counseling for nutrition• Counseling for physical activity

W34 Well-Child Visits in the 3rd, 4th, 5th, & 6th Years of Life

Percentage of members 3-6 years of age who had one or more well-child visits with a PCP during the measurement year

*-Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures). The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

17

Recurrence Measure Incentive Initiative Type

Monthly All N Member Outcall

Annual (Sept)Multiple TBD - still being defined under Project Homeless Connect Y Community Event

Annual (Aug)Multiple TBD - promoting well care and preventive screenings N Community Event

Annual (Aug)Multiple TBD - promoting well care and preventive screenings N Community Event

Monthly•PPC •CIS-10 •URI • CAP •CWP •WCC •WCV •MMA •AMR •ADD •IMA N Provider Education

Quarterly All N Provider Newsletter

QI Initiatives Calendar - HEDIS Score Improvement

Quarter 3: July - September

Member engagement, provider partnerships, and community involvement represent key drivers to achieving improved HEDIS performance. As part of PHC's HEDIS Score Improvement 2019 Tactical Plan, proactive planning and coordination of member and provider outreach activities has culminated into a master QI Initiatives Calendar. A series of Initiative type categories have been defined for which upcoming plan-wide and regional initiatives are summarized below.

Ongoing Northern Region Initiatives:

18

Month Measure Incentive Initiative TypeN Misc. (General Education)N Point of Service InteractionN Point of Service Interaction

CIS-3 N Outreach/Scheduling CallsN Outreach/Scheduling CallsN PHC Population Reports

CCS N Outreach/Scheduling CallsCDC - Eye Exam N Misc. (General Education)

N Outreach/Scheduling CallsN Outreach/Scheduling CallsN PHC Population ReportsN Outreach/Scheduling Calls

Y Poster Campaign, School Engagement

PPC - Prenatal Care Y Outreach/Scheduling CallsPPC - Postpartum Care Y Outreach/Scheduling Calls

N Outreach/Scheduling CallsY Birthday ClubN Provider EducationN Misc. (General Education)N Point of Service InteractionN Point of Service InteractionN Provider Education

BCS N Outreach/Scheduling CallsCIS-3 N Outreach/Scheduling CallsCIS-10 N Outreach/Scheduling CallsCCS N Outreach/Scheduling CallsCDC - Eye Exam N Misc. (General Education)

Y Outreach/Scheduling CallsN Outreach/Scheduling CallsN Outreach/Scheduling Calls

Y Poster Campaign, School Engagement

PPC - Prenatal Care Y Provider EducationPPC - Postpartum Care Y Provider Education

N Outreach/Scheduling CallsY Birthday ClubN Provider EducationN Misc. (General Education)N Outreach/Scheduling CallsN Provider Education

CIS-3 N Outreach/Scheduling CallsCDC - Eye Exam N Misc. (General Education)

N Outreach/Scheduling CallsMedia Campaign

Y Provider EducationPPC - Prenatal Care Y Outreach/Scheduling CallsPPC - Postpartum Care Y Outreach/Scheduling CallsW34 Y Birthday Club

IMA-2

W34

July

August

September

AMR

W34

IMA-2

IMA-2

AMR

CIS-10

Northern Region Initiatives

AMR

19

Month Measure Incentive Initiative TypeCIS-3 N On Hold Messages

IMA-2 N Community Event

PPC - Prenatal Care Y Outreach/Scheduling CallsPPC - Postpartum Care Y Outreach/Scheduling CallsW15 Y Outreach/Scheduling CallsCDC - Eye Exams N Education & Reminder

Y Birthday ClubN Provider Blast (email or fax)

Y Community Event

Y Birthday Club

N Community Event

N Outreach/Scheduling CallsN On Hold Messages

PPC - Prenatal Care Y Outreach/Scheduling CallsPPC - Postpartum Care Y Outreach/Scheduling CallsAWC N Education & Reminder

N On Hold MessagesN Education & ReminderN Provider Blast (email or fax)N Website

N Community Event

N WebsiteN Education & Reminder

W15 N WebsiteW34 Y WebsiteCIS-3 Y Birthday Club

N On Hold MessagesY Outreach/Scheduling CallsN Website

PPC - Prenatal Care Y Outreach/Scheduling CallsPPC - Postpartum Care Y Outreach/Scheduling Calls

Southern Region Initiatives

September

WCC (BMI)

BCS

July

August

W34

CIS-3

CIS-10

IMA-2

20

Initiative Type DefinitionOutreach/ Scheduling Calls Calls from PHC or a provider office to members to remind them

about scheduling needed servicesBirthday Club Postcard and outreach call to member or parent/ guardian of a

member the month before their birthday to remind them of missing services. Incentives are provided

Community Event Health fairs, screening events, community based screening sessions where PHC contacts members to attend

Scheduling Block Clinic days at provider sites/ health centers where blocks of appointment time are set for PHC members to receive missing services

Poster Campaign, School Engagement

Educational events where students create art projects that amplify a health topic such as immunizations; engagements with screening sessions at school clinics

Provider Newsletter Quarterly publication by the Provider Relations department with dedicated space for QI articles

Provider Education Coaching, measure review and in-depth guidance for providers on HEDIS/ QIP measures

Member Newsletter Semi-annual publication by the member services department with dedicated space for QI articles

PHC Population Reports(AKA Gap Lists)

Lists of members with missing services given to providers for specific measures for direct outreach and scheduling; often accompanied by follow-up phone call from a PHC Medical Director

Provider Blast (email or fax) Communication to all network providers to communicate information

Website Changing banners to communicate health information to members or providers.; Posting information to the member or provider sections of the website,

Misc. (General Education) General reminders/ other education to members Education & Reminder Birthday Month Calls: Proactive calling of members to inform and

empower them by tying particular preventive screenings to their birthday month every year. These types of calls are deployed as an investment in achieving longer term behavior changes by which members begin to associate healthcare behaviors with their birth month.

Special Calls Special Calls: Calendar-related reminder calls in correspondence with national health awareness months – i.e. heart health month, women’s health month, etc. These may have short-term measure specific impact and less sustainable effects unless repeated year over year – like Birthday Month calling.

End-of-Year Calls End-of-Year (Sprint) Calls: Calls targeting members delinquent on at-risk HEDIS measures (i.e. per HEDIS gap lists as of mid-year or later) for the purpose of improving scores before the current measurement year closes.

Member Outcall Calls placed to members without claims in 12 months to connect them to their PCP or assist with PCP reassignment

On Hold Messages Messages about health information, preventive health services that members can listen while on hold to talk to a member services representative

Point of Service Interaction Inform members of screening and/or medication needs at the point of service, in pharmacy or provider settings

Member Letters Postcards sent to members to remind them of services needed and to connect with their PCP

Media Campaign Social media campaign focused on improving member education and influencing member decision-making in preventive services/screenings

21

Healthcare Effectiveness Data and Information Set (HEDIS ... HE… · Healthcare Effectiveness Data...

Documents

Transcript of Healthcare Effectiveness Data and Information Set (HEDIS ... HE… · Healthcare Effectiveness Data...