Ohana health plans quality improvement qi program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services. Welcome to the population health hedis home page reference and resource materials are being replaced periodically, so check back here for updates. Aco reporting and related incentives are becoming extremely important for healthcare providers in the us. Hedis 101 for providers 2019 improving quality of care authors commercial and. Do not count biopsies, breast ultrasounds or mris for this measure because they are not. Assesses adults and children 564 years of age who were identified as having persistent asthma and were dispensed appropriate asthmacontrolled medications that they remained on for at least 75% of their treatment period. Hedis performance measures antidepressant medication. Hedisataglance is a reference guide designed to help your practice provide the best quality care, in alignment with the hedis standards. Hedis is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need. Provider resources gold coast health plan gold coast.
Hedis trends in medical hedis 20152017 my acronym hedis measures hedis 2015 cy 2014 hedis 2016 cy 2015 hedis 2017 cy 2016 rate difference cy 20152016 percentile ranking antidepressant. Pcp hedis quick reference guide universal american. Managed care, hedis database development, software, design. Condition specific care cardiovascular cholesterol management for members with cardiovascular condition adults 18 years age 18 and older75 members who were discharged alive 010112 12312012 for. Updated to reflect ncqa hedis 2019 technical specifications. We maintain a robust provider network that includes more than 3600 providers, 187 pharmacies and most of the local hospitals and longterm care facilities in ventura county. 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. Medicaid adult quality measures template do not certify. Preventive care, chronic disease management, behavioral health care, and perinatal care. Hedis provider reference guide 2019 pdf buckeye health plan. Hedis is the gold standard for measuring quality health care performance, and is part of the ncqa accreditation process.
Hedis measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes. Cardiovascular monitoring for people with cardiovascular. Measure evaluates percentage of members 18 years of age and older who were treated with. Antidepressant medication s play a critical role in the effective care of patients with depression. Hedis 2020 quick reference guide coordinated care health. Adults who remained on an antidepressant medication. The points assignment for the ppe measures is analogous to the points assignment for the hedis. The tables below explain the national committee for quality assurance ncqa healthcare effectiveness data and information set hedis measures for two types of care. To make the most of your office visits towards meeting hedis measures, please document the following criteria as applicable. Weight assessment and counseling for nutrition and physical activity for childrenadolescents. The office of personnel management opm requires reporting of the following hedis measures for 2014. Preventive health care 900393509 women and adolescent girls breast cancer screening age 50 74 tech spec change as of 720 from age 40 percentile and counseling for women who had a mammogram to screen. All hedis 2015 measures must be submitted to ncqa by 11.
The measures included in this report assess health care quality in four key areas. Visitors to this page often check hedis faqs, qrs faqs, or ask a question through myncqa. Cms has released 33 aco quality measures that need to be reported which is very effort and cost intensive for healthcare organizations. The healthcare effectiveness data and information set hedis is one of health cares most widely used performance improvement tools. There are two types of hedis data reffered to in this guide.
Louisiana healthcare connections is committed to maintaining the necessary data for accurately assessing and comparing our plans performance against adopted hedis measures. Amm antidepressant medication management lbp use of imaging studies for low back pain. Pp etor ne nion ure niverit treet uite ettle pp etor. Hedis performance measures 1 antidepressant medication management the percentage of medicaid enrollees age 18 and older with a diagnosis of major depression and were treated with antidepressant medication, and who remained on an antidepressant medication treatment. The provider manual describes operational policies and procedures relative to the provision of health care services to gold coast health plan members. This section is designed exclusively for our providers who can access. Aim to enhance quality of care and reduce costs by meeting performance measures and three criteria. Gold coast health plan and its providers are committed to delivering quality care to their members. We leverage the most current technologies so you can reap the benefit of additional resources at a fraction of the cost.
Behavioral health antidepressant medication management. Medication management for people with asthma and asthma. Hedis is a nationally standardized set of measures related to important areas of care and service. Apmbh does not differ on age from the hedis source measure. A cross section of key staff from multiple departments serve on our hedis steering committee in order to provide strategic recommendations and dedicated. Acute myocardial infarction ami coronary artery bypass graft cabg percutaneous coronary. The ub codes contained in the hedis specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting hedis results or using hedis measure results for their internal quality improvement purposes. The purpose of this measure is to evaluate primary screening. We understand that hedis specifications can be complex, so we have designed this manual to clearly define molinas criteria for meeting hedis guidelines. Ncqa develops hedis measures through a committee represented by purchasers, consumers, health plans, health care providers, and policy makers. Masshealth hedis 2014 measures masshealth selected 17 measures for the hedis 2014 report. There was a statistically significant change from sfy 20 to sfy 2014 for the 30day followup.
Percent members 18 years of age and older with a diagnosis of major depression and were treated with antidepressant medication, and who remained on an antidepressant. Behavioral health clinics clarifications to guidance. Hedis measure memberdescription documentation requirements codes antidepressant medication management amm members 18 years of age and older as of april 30 of the measurement year who were treated with antidepressant medication, had a diagnosis of major depression and remained on an antidepressant medication. Commercial adult health care 90045460614 90045460614 women adults breast cancer screening age 50 74 women who had a mammogram to screen for breast cancer discharged alive from 0701 documentation of mammogram between oct. Women who had a bilateral mastectomy, or two unilateral mastectomies. 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. We welcome your comments on how to improve the information posted. Each year, blue cross and blue shield of illinois bcbsil reports audited health care effectiveness data and information set hedis results. Both rates are well above the hedis 2014 50th percentile benchmark.
Direction of arrow indicates the change in performance from sfy 20 to sfy 2014. Qi may conduct annual medical record audits in physician offices. All hedis measure information has been extracted from the ncqa hedis 2014 technical specifications volume 2 55 1220 cardiovascular monitoring for people with cardiovascular disease and schizophrenia smc 2014 hedis measure measurement year is defined as the calendar year in which care is rendered which members meet the measure. Easily identifies statewide and hh improvement from 2014 through 2016. All hedis measure information has been extracted from the ncqa hedis 2014 technical specifications volume 2 55 1220 diabetes monitoring for people with diabetes and schizophrenia smd 2014 hedis measure measurement year is defined as the calendar year in which care is rendered which members meet the measure. We created the hedis quick reference guide to help you increase your practices hedis rates. Ncqa is a nonprofit organization dedicated to improving health care quality.
Antidepressant medication management amm why is this measure important. Discuss the effective application of the hedis measures in managed care and clinical settings differentiate outcomes in managed care that may be achieved with the amm measure opportunities for improvement the hedis antidepressant medication management amm measure. Guide to hedis measures is a reference guide designed to help your practice provide the. Ncqa established healthcare effectiveness data and information set hedis measures specifically for snps. Nov 5, 2015 antidepressant medication management amm. The consequences of untreated or inadequately treated depressi on are significant and taking antidepressant. Hhsc uniform managed care manual page hhsc uniform managed care manual 6. These performance measurements are a gauge of how well cchps contracted networks and systems of care deliver services in an accessible, efficient, and effective manner in comparison to other health plans. Premera blue cross blue shield of alaska is an independent licensee of the blue cross blue shield association 032651 04172018 antidepressant medication management amm.
Quick reference guide women measure description required documentation prenatal care for live births between 116 11514 uterus women who had a p renatal visit within the first trimester or within 42 days of enrollment documentation of d ated prenatal visit and one of the following. Pcp hedis quick reference guide for primary care providers hedis measure measure requirements recommended services. Medicaid adult quality measures 2014 2 reporting of the core set of health care quality measures for medicaideligible adults medicaid adult core set background section 19b of the affordable care act required the secretary of the department of health and human. This manual is intended to be an easytofollow guide that covers the hedis measures applicable to medical and medicare. Updated to refect ncqa hedis 2020 technical specifcations. Management amm the percentage of members 18 years and older with a diagnosis of major depression who were newly treated with antidepressant medication.
Metrics and quality measures for behavioral health clinics. The results reported in 2014 will be based on services provided in calendar year 20 or earlier, as specified in the national committee for quality assurance ncqa 2014 hedis specifications. 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. Rates developed using hedis or nys measure specifications rates will then be updated quarterly. Antidepressant medication management amm assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on their antidepressant medications. 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. Hedis training manual 2014 data collection and abstraction. Healthcare effectiveness data and information set hedis. Hedis measure physician documentation guidelines and. Buckeye health plan 2019 hedis quick reference guide. Hedis provider toolkit 2017 washington molina healthcare.
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