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

2. 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

3. 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

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

5. NCQA Health Insurance Plan Ratings NH Health Plans

6. NCQA Health Insurance Plan Ratings CT Health Plans

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

8. NCQA Health Insurance Plan Ratings Plan Detail Report

9. NCQA Health Insurance Plan Ratings Plan Detail Report- continued

10. NCQA Health Insurance Plan Ratings Plan Detail Report- continued

11. NCQA Health Insurance Plan Ratings Plan Detail Report- continued

12. 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

13. 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

14. 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

15. 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

16. 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