Please visit our provider web page for additional hedis measure specifications, information, resources, and guidance. This tip sheet details the key aspects of the specific hedis measures for adult bmi, provides useful administrative aids and offers guidance and resources. Hedis is a set of standardized performance measures developed by the national committee for quality assurance ncqa which allows comparison across health plans. This document details some of the key features of the hedis. The measurement period was identified by dch as cy 2018 for all measures table 2 lists the performance measures that hsag validated, the method required by dch for data collection, and the specifications the cmo was required to use for each of the measures. 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 as important dimensions of customer satisfaction and patient experience. Validation of performance measures georgia medicaid. The previous calendar year is the standard measurement year for 2016 hedis for qrs data. Final audited hedis measure results from ncqas interactive data submission system idss were submitted to hsag and provided to dch.
Hedis is a registered trade mark of the national committee for quality assurance ncqa. Hedis 2017 calendar year 2016 data hedis is a yearround effort. The annual report communicates a comprehensive representation of nj familycare operations during the calendar year. That makes hedis one of health cares most widely used performance improvement tools. For measures with a look back period further than oct. My 2016 value based p4p hedis 201 7 pharmacy table c. For example, most hedis rates reported in 2016 are based on clinical services performed in 2015. 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. Hedis quick reference guide updated to reflect ncqa hedis 2016 technical specifications mhs health wisconsin strives to provide quality healthcare to our membership as measured through hedis quality metrics. The tables below explain the national committee for quality assurance ncqa healthcare effectiveness data and information set hedis measures for two types of care. Use population health management software to identify patients in need of preventive health services. Michigan quality improvement consortium detailed measurement. Key ways blue cross blue shield raises its hedis scores. Hedis ataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards.
Qiphedis measure webinar series partnership healthplan. Hedis indicators have been designed by ncqa to standardize performance measurement and do not necessarily represent the ideal standard of care. We created the hedis quick reference guide to help you increase your practices hedis rates. Calendar days covered with prescriptions within the specified. If your office uses manual blood pressure cuffs, dont round up the bp. Ensuring hediscompliant provider portal features preventive. Plans certified during 2016 are required to submit enrollment by product line and any other measures where members meet hedis eligibility criteria.
The dental measure was reported for federal fiscal year ffy 2016, which covered the time frame of october 1, 2015, through september 30, 2016, according to cms requirements. An 11month period that begins on january 1 of the measurement year and. Listed codes are examples acceptable for hedis 919 appropriate treatment for with uri. 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. Ncqa is a nonprofit organization dedicated to improving health care quality.
Providers play a critical role in the outcome of hedis measures. Hedis is a retrospective process hedis 2017 calendar year 2016 data hedis is a yearround effort. 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. My 2016 value based p4p hedis 201 7 pharmacy table c rosswalk. Hedisataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards. Adult bmi assessment aba weight assessment and counseling for nutrition and physical. Manage your healthcare outcomes aapc knowledge center. General tips and information that can be applied to most hedis measures. The updated presentation provides an overview of the hedis measures that gchp reports and the ncqas updates and changes to these measures.
Provider operations bulletin gold coast health plan. For a complete overview of the hedis volumes, see the hedis publications. Hedis consists of 80 measures across five domains of care that address important health issues. Executive summary the ohio department of medicaid odm has established quality measures and standards to evaluate managed care plan mcp performance in key program areas. Validation of performance measures georgia department of. Hsag will use these results in addition to the measures hsag validated as data. 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. Annual hedis calendar jan may clinical quality staff initiates medical record requests and collection from our providers. The 2016 hedis measures for qrs contained in this document are ed by. Hedis 101 for providers aetna better health of kentucky 2017.
Gchps quality improvement department has posted the updated presentation, introduction to hedis 2016, on gchps website. Your 2016 guide to key hedis measures keywords healthcare effectiveness data and information set hedis measures help keystone first monitor care and identify opportunities to improve access to preventive and recommended services. Reporting hedis rates hedis measures evaluate the previous years clinical data. This section includes measure specifications and data collection guidelines for ncqas hedis measures and the pqa measure in the qrs measure set. Click here to view the presentation, introduction to hedis 2016. Hedis is the gold standard for measuring quality health care performance, and is part of the ncqa accreditation process. A guide to understanding medicaid measure compliance. Appendix d displays the final audited hedis 2016 results for all required measures, covering the cy 2015 measurement period. The healthcare effectiveness data and information set hedis is a tool that helps health plans measure the quality of care their members receive. Healthcare effectiveness data and information set hedis. Hedis measures evaluate the previous years clinical data. The healthcare effectiveness data and information set hedis is one of health cares most widely used performance improvement tools.
Hedis healthcare effectiveness data and information set is one tool we use to measure many aspects of performance. Your 2016 guide to key hedis measures keystone first. Adhd medication who had at least three followup care visits within a 10month period. To approximate the hedis metric, this study used a retrospective longitudinal cohort design with calendar year. The michigan quality improvement consortium mqic is a group of physicians, administrators, researchers, and quality improvement experts from michigan. That makes hedis one of health care s most widely used performance improvement tools.
Ncqa accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of hedis, the tool the nation. Department of human services news, publications, reports. Hedis hedis is a set of standardized measures used to evaluate performance in the health care industry. Claimsencounter hybrid measures measures a statistically significant. Ncqa has expanded the size and scope of hedis to include measures for physicians, ppos and other organizations. Factors associated with adherence to the hedis quality. Adult bmi assessment florida blue wants to help improve your quality ratings. Staying ahead is the best way to keep from falling behind, especially when it comes to the hedis submission process. For onsite chart collections, the office will be contacted to schedule a time the. In order to differentiate marylandonly data from bookofbusinessdata, commercial health benefit plans shall determine whether a member is a maryland resident based on the members residency in the state of maryland on december 31, 2016 or their last known address. Hedis includes more than 90 measures across 6 domains of care. Key ways blue cross blue shield raises its hedis scores we have contracts that are based on quality measures and we have. The final hedis 2017 ndc lists are located on the ncqa website.
Buckeye uses hedis data to identify areas for improvement and monitor progress. For example, if the hedis 2017 screening measure is used as the baseline screening rate for clinic 1 for the calendar year january 1 through december 31, 2017, the hedis screening measure needs to be reported for that clinic for all subsequent years calendar years 2018, 2019, 2020, and so on. Percentage of members 1875 years of age with diabetes type 1 and type 2 who had. This study compared adherence to the hedis measure among patients with. Factors associated with adherence to the hedis quality measure in medicaid patients with schizophrenia. Guide to hedis measures is a reference guide designed to help your. Hedis measures are reported as administrative or hybrid and are. Research and qualitys ahrqs quality indicator measures. Guidance for measuring breast, cervical, and colorectal. For on site chart collections, the office will be contacted to schedule a time the. Visitors to this page often check hedis faqs, qrs faqs, or ask a question through myncqa. Some measures, such as cervical cancer screening, look for services performed up to 5 years prior to the reporting year. Magnolia health strives to provide quality healthcare to our membership as measured through hedis quality metrics.
Hedis 2017 is published across a number of volumes and includes 91 measures. The hedis ltss learning collaborative is a joint effort between ncqa and organizations providing ltss toexplore reporting the new volume of hedis 2019 technical specifications. Reimbursement for these services is in accordance with the terms and conditions of your provider agreement. Table 11colorado medicaid statewide weighted averages. This hedis calendar lists monthly milestones and important dates to keep you organized yearround. Aim to enhance quality of care and reduce costs by meeting performance measures and three criteria. Hedis measures performance in health care where improvements can make a meaningful difference in peoples lives.
Hedis includes measures for physicians, ppos and other organizations. Monthly health messages controlling high blood pressure. Administrative measures measures the entire eligible population data collected through transaction data or other administrative data used to identify the eligible population and numerator i. Who is the michigan quality improvement consortium. Managed long term care medicaid advantage and medicaid. Clinical quality hedis 2016 summary healthcare effectiveness data and information set 1 s group health performance is above national average t group health performance is below national average. For example, most hedis rates reported in 2016 are based on. Factors associated with adherence to the hedis quality measure in.