Effectiveness of Care Measures 2017 HEDIS Performance Effectiveness of Care Measures MA Medical Directors Meeting

HEDIS Effectiveness Of Care Measures Public Reporting All EOC Measures publically reported in annual release of Quality Compass Some EOC measures used for NCQA Accreditation Most EOC measures used for NCQA Health Insurance Plan Ratings 2 2

NCQA / Consumer Reports Reminder NCQA Health Insurance Plan Ratings Overall rating is calculated on a scale 1-5 (5 is highest) in half point increments Health Plan rating includes three subcategories (also scored 1-5) Consumer Satisfaction Prevention and Treatment NCQA Accreditation standards score 3 3

NCQA Health Insurance Plan Ratings Massachusetts Health Plans Massachusetts only plans-

NCQA Health Insurance Plan Ratings NH Health Plans

NCQA Health Insurance Plan Ratings CT Health Plans

NCQA Health Insurance Plan Ratings Plan Summary Report Summary level of ratings

NCQA Health Insurance Plan Ratings Plan Detail Report

NCQA Health Insurance Plan Ratings Plan Detail Report- continued

NCQA Health Insurance Plan Ratings Plan Detail Report- continued

NCQA Health Insurance Plan Ratings Plan Detail Report- continued

HEDIS 2018 Overview Notable Changes to Existing Measures: Breast Cancer screening Added Digital Breast Tomosynthesis (3D mammogram) as method for meeting screening requirement. Immunizations for Adolescents Two dose option for Human Papillomavirus Vaccination At least two HPV vaccines, with different dates of service on or between the member’s 9th and 13th birthdays. There must be at least 146 days between the first and second dose of the HPV vaccine. For example, if the service date for the first vaccine was March 1, then the service date for the second vaccine must be after July 25. 12 12

HEDIS 2018 Overview New Effectiveness of Care Measures Transitions of Care (Medicare only)- hybrid methodology The percentage of discharges for members 18years and older who had each of the following in the measurement year. Four rates reported: Notification of Inpatient Admission- Documentation of receipt of notification of inpatient admission on the day of admission or the following day. Receipt of Discharge Information - Documentation of receipt of discharge information on the day of discharge or the following day. Patient Engagement After Inpatient Discharge- Documentation of patient engagement (e.g., office visits, visits to the home, telehealth) provided within 30 days after discharge. Medication Reconciliation Post-Discharge. Documentation of medication reconciliation on the date of discharge through 30 days after discharge. Follow-Up After Emergency Department Visit for People With High-Risk Multiple Chronic Conditions (Medicare only) The percentage of emergency department (ED) visits for members 18 years and older who have high-risk multiple chronic conditions who had a follow-up service within 7 days of the ED visit. 13 13

HEDIS 2018 Overview continued New Effectiveness of Care Measures, continued ECDS Measures- Electronic Clinical Data Systems Depression Screening and Follow-Up for Adolescents and Adults The percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care within 30 days. (2 rates reported). Unhealthy Alcohol Use Screening and Follow-Up The percentage of members 18 years of age and older who were screened for unhealthy alcohol use using a standardized tool and received appropriate follow-up care within two months if they screened positive. (2 rates reported). Pneumococcal Vaccination Coverage for Older Adults The percentage of members 65 years of age and older who have ever received the recommended series of pneumococcal vaccines: 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23). 14 14

HEDIS 2018 Overview continued New Effectiveness of Care Measures, continued Developed by the Pharmacy Quality Alliance (PQA) and adapted by NCQA Use of Opioids at High Dosage (all products, lower rate is better) Members 18 years and older, rate per 1,000 receiving prescription opioids for ≥ 15 days during the measurement year at a high dosage dosage (average morphine equivalent dose [MED] >120 mg). Use of Opioids from Multiple Providers (all products, lower rate is better) Members 18 years and older, rate per 1,000 receiving prescription opioids for ≥15 days during the measurement year who received opioids from multiple providers. Three rates are reported. Multiple Prescribers: The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers during the measurement year. Multiple Pharmacies: The rate per 1,000 of members receiving prescriptions for opioids from four or more different pharmacies during the measurement year. Multiple Prescribers and Multiple Pharmacies: The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers and four or more different pharmacies during the measurement year. 15 15

How can we collaborate? Extracts from EMRs are ideal !! Reduce the number of medical records requested by HPHC Less work for medical practice staff to pull HEDIS records Do you provide data extracts to other insurers, vendors? HPHC may be able to incorporate these feeds into our process Leverage existing feeds to limit effort necessary for medical practices Who can we talk to ? HEDIS contact at the LCU/practice? Someone we are able to speak with to educate on the type of data required before information is sent back to HPHC. Contact required when information is incomplete. 16 16