HEDIS 2017 results are in for our Anthem PPO and Anthem HealthKeepers products

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1 HEDIS 2017 results are in for our Anthem PPO and Anthem HealthKeepers products Anthem Blue Cross and Blue Shield thanks you for participating in the annual Healthcare Effectiveness Data and Information Set (HEDIS) data collection project for 2017 impacting members enrolled in our Anthem PPO and Anthem HealthKeepers (excluding Medicaid) products. You play a central role in promoting the health of our members. By documenting services in a consistent manner, it is easy for you to track care that was provided and identify any additional care that is needed to meet the recommended guidelines. Consistent documentation and responding to our medical record requests in a timely manner eliminates follow-up calls to your office and also helps improve HEDIS scores, both by improving care itself and by improving our ability to report validated data regarding the care you provided. The records that you provide to us directly affect the HEDIS results that are listed below. Each year, our goal is to improve our process for requesting and obtaining medical records for our HEDIS project. In order to demonstrate the exceptional care that you have provided to our members and in an effort to improve our scores, you and your office staff can help facilitate the HEDIS process improvement for members enrolled in our Anthem PPO and Anthem HealthKeepers health products by: Responding to our requests for medical records within five days if at all possible Providing the appropriate care within the designated timeframes Accurately coding all claims Documenting all care clearly in the patient s medical record Further information regarding documentation guidelines and administrative codes can be found on the HEDIS page of our provider portal. In addition, more information on HEDIS can be found by visiting the provider portal at: (from the menu prompt at top of the screen, select) > Provider > Virginia > Health & Wellness > Quality Improvement and Standards > HEDIS Information. You will find reference documents entitled HEDIS 101 for Providers and HEDIS Physician Documentation Guidelines and Administrative Codes. IMPORTANT NOTE: The following information pertains only to our Anthem PPO and Anthem HealthKeepers lines of business and does NOT include results for Anthem HealthKeepers Plus (Medicaid), Medicare Advantage, the Medicare-Medicaid Plan (MMP) under the Commonwealth Coordinated Care Plan, or the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program or FEP ). The following table shows some of our key measure rates across Virginia. Yellow boxes indicate rates that are above the national average. Bold indicates improvement in rate over the previous year. NR = Not Reported, NA = Not Applicable denominator too small Comprehensive Diabetes Care - Poor HbA1c Control (>9): Lower rate is good HEDIS 2017 Results Network Update December 2017 Page 1

2 HEDIS 2017 Anthem PPO and Anthem HealthKeepers Health Products Measure Name Effectiveness of Care Prevention and Screening VA Anthem HealthKeepers VA PPO Adult BMI Assessment Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - BMI Total Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - Counseling for Nutrition Total Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - Counseling for Physical Activity Total Childhood Immunization Status - Combo Childhood Immunization Status - Combo Immunizations for Adolescents - Combo 1 Breast Cancer Screening Ages Total Cervical Cancer Screening Colorectal Cancer Screening Chlamydia Screening in Women - Total Effectiveness of Care Respiratory Conditions Appropriate Testing for Children With Pharyngitis Use of Spirometry Testing in the Assessment and Diagnosis of COPD Pharmacotherapy Management of COPD Exacerbation (Corticosteroid) Pharmacotherapy Management of COPD Exacerbation (Bronchodilator) Effectiveness of Care Cardiovascular Controlling High Blood Pressure Persistence of Beta-Blocker Treatment after a Heart Attack HEDIS 2017 Results Network Update December 2017 Page 2

3 Effectiveness of Care Diabetes Comprehensive Diabetes Care - HbA1c Testing Comprehensive Diabetes Care - Poor HbA1c Control (>9) Comprehensive Diabetes Care HbA1C Good Control (<8) Comprehensive Diabetes Care - Eye Exams Comprehensive Diabetes Care Blood Pressure Control <140/90 Effectiveness of Care Musculoskeletal Disease Modifying Anti-Rheumatic Drug Therapy Imaging Studies for Low Back Pain Effectiveness of Care Medication Management Annual Monitoring for Patients on Persistent Medications Total Access/Availability of Services Prenatal and Postpartum Care - Timeliness of Prenatal Care Prenatal and Postpartum Care - Postpartum Care Utilization and Relative Resource Use Utilization Well Child Visits in the First Fifteen Months of Life (6+ visits) Well Child Visits in the Third, Fourth, Fifth and Sixth Year of Life Adolescent Well Care Visits ^^^Due to changes in the measure, it is not trendable for previous years In Virginia, there were many Anthem HealthKeepers and Anthem PPO lines of business rates improved and/or exceeded the national average. Measures with rate increases include: Anthem HealthKeepers line of business rates that were improved and exceeded the National Average: Adult BMI Assessment Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - BMI Total Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - Counseling for Nutrition Total HEDIS 2017 Results Network Update December 2017 Page 3

4 Appropriate Testing for Children With Pharyngitis Comprehensive Diabetes Care HbA1C Good Control (<8) Well Child Visits in the First Fifteen Months of Life (6+ visits) Anthem HealthKeepers line of business with measure rate increases that did not meet or exceed the National Average: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - Counseling for Physical Activity Total Childhood Immunization Status - Combo 2 Childhood Immunization Status - Combo 3 Breast Cancer Screening Ages Total Cervical Cancer Screening Colorectal Cancer Screening Pharmacotherapy Management of COPD Exacerbation (Corticosteroid) Persistence of Beta-Blocker Treatment after a Heart Attack Disease Modifying Anti-Rheumatic Drug Therapy Annual Monitoring for Patients on Persistent Medications Total Anthem HealthKeepers line of business measures that showed rate decreases and have opportunities for improvement: Controlling High Blood Pressure Prenatal and Postpartum Care - Postpartum Care Well-Child Visits in the first 15 Months of Life (2 visits) Well-Child Visits in the first 15 Months of Life (3 visits) Anthem HealthKeepers line of business that showed notable rate improvements in several measures include: Comprehensive Diabetes Care - HbA1c >9 Well-Child Visits in the first 15 Months of Life (1 visit) Well-Child Visits in the first 15 Months of Life (0 visits) HEDIS 2017 Results Network Update December 2017 Page 4

5 Anthem PPO Line of Business Rates that were improved and exceeded the National Average: Adult BMI Assessment Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - BMI Total Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - Counseling for Nutrition Total Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - Counseling for Physical Activity Total Childhood Immunization Status - Combo 2 Childhood Immunization Status - Combo 3 Colorectal Cancer Screening Comprehensive Diabetes Care HbA1C Good Control (<8) Comprehensive Diabetes Care Blood Pressure Control <140/90 Annual Monitoring for Patients on Persistent Medications Total Prenatal and Postpartum Care - Timeliness of Prenatal Care Anthem PPO line of business with measure rate increases that did not meet or exceed the National Average: Breast Cancer Screening Ages Total Cervical Cancer Screening Appropriate Testing for Children With Pharyngitis Controlling High Blood Pressure Persistence of Beta-Blocker Treatment after a Heart Attack Comprehensive Diabetes Care - HbA1c Testing Comprehensive Diabetes Care - Eye Exams Disease Modifying Anti-Rheumatic Drug Therapy Well Child Visits in the First Fifteen Months of Life (6+ visits) Well Child Visits in the Third, Fourth, Fifth and Sixth Year of Life HEDIS 2017 Results Network Update December 2017 Page 5

6 Measures where there are opportunities for improvement include: Anthem PPO line of business measures that showed rate decreases and have opportunities for improvement: Well-Child Visits in the first 15 Months of Life (5 visits) Use of Imaging Studies for Low Back Pain Anthem PPO line of business that showed notable rate improvements in several measures include: Weight Assess/Counseling - BMI yrs. Weight Assess/Counseling - Nutrition Counseling yrs. Immunizations for Adolescents - Combo 1 Well-Child Visits in the first 15 Months of Life (0 visits) Again, we thank you and your staff for demonstrating teamwork, as we work together to improve the health of our members and your patients. We look forward to working with you again next HEDIS season. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA) Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are independent licensees of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. HEDIS 2017 Results Network Update December 2017 Page 6