2017 Annual Report Healthcare Effectiveness Data and Information Set (HEDIS) Prepared by the Health Plan s Quality Management Department

Transcription

1 2017 Annual Report Healthcare Effectiveness Data and Information Set (HEDIS) Prepared by the Health Plan s Quality Management Department

2 Table of Contents Executive Summary 3 Introduction 5 Description of Healthcare Effectiveness Data and Information Set (HEDIS) 5 Data Collection and Methodology 5 Data Completeness and Limitations 6 Performance Evaluation of Product Lines 6 Commercial Plans for County Employees 7 Medicare 8 Medi-Cal 9 Medi-Cal Performance Charts 10 Additional Measures for Accreditation 22 Stratifications of the Data and Disparities Identified 23 Comparison of Care Networks 23 Disparities Identified Through Stratification by Ethnicity 24 Prioritization of Measures for Improvement Annual HEDIS Report Page 2 of 28

3 Executive Summary Contra Costa Health Plan (CCHP) is pleased to present a summary of our most recent performance measurement rates. The measures reported are known as the Healthcare Effectiveness Data and Information Set (HEDIS). Established by the National Committee for Quality Assurance (NCQA), these measures are standardized quality indicators used to compare health plans and providers across the nation. Our different contracts specify which measures we must report. Since the measures are required of virtually all plans, benchmarking using national Medicaid Health Maintenance Organization (HMO) or State Medicaid averages is possible and included in this report. Benchmark peer groups vary depending on the product line and are chosen based upon what is the most comparable population. A summary of the results by product follows. County Benefits For County Employees, four measures are used. Three of the four CCHP measures were higher than the nationwide 2016 Commercial HMO average as reported by NCQA in the data warehouse titled, 2016 Quality Compass. Medi-Cal Medi-Cal is CCHP s largest population, with over % of our members. This year, CCHP improved on 15 of the 24 Medi-Cal measures. Four declined; five were new or changed so they had no comparative data. 13 of the 18 measures with comparative data scored above the Medi-Cal mean. This year, we have 3 measures above the national Medicaid th percentile (High Performance Level or HPL): Avoidance of Antibiotics for Bronchitis, Timely Postpartum Care, Timely Prenatal Care, and Physical Activity Counseling. We have one measures below the national Medicaid 25 th percentile (Minimum Performance level or MPL): Nephropathy screening or treatment for Diabetics. The following measures declined more than 5 points, Well Visits 3-6 Years, Avoidance of Imaging for Low Back Pain, Retinal Eye Exams for Diabetics Annual HEDIS Report Page 3 of 28

4 The problem with Kaiser data on asthma seen last year, was not repeated this year. In addition to the measures required by Medi-Cal, we collected data on additional measures required for NCQA Accreditation. There is no Medi-Cal mean for these. Most measures were above the Medicaid HMO nationwide mean. Medicare Three of the thirteen measures are above the national Medicare mean. An additional three are within a point of the mean. A Note on Timeframes and Terminology This report refers to HEDIS is the reporting year. Most of the activity reflected in these measures occurred in 2016, although some measures have longer lookback periods Annual HEDIS Report Page 4 of 28

5 Introduction CCHP is pleased to present a summary of our HEDIS performance measurement rates. These performance measurements are a gauge of how well CCHP s contracted networks and systems of care deliver services in an accessible, efficient, and effective manner in comparison to other health plans. Description of Healthcare Effectiveness Data and Information Set (HEDIS) The State of California, Department of Health Care Services (DHCS) requires all health plans managing state Medicaid benefits ( Medi-Cal ) to utilize an External Accountability System (EAS). The EAS ensures high quality services that meet Federal and State requirements established by the Centers for Medicaid and Medicare Services (CMS). This requirement is met by CCHP by collecting and reporting the set of performance measures known as the HEDIS. Originating from the National Committee for Quality Assurance (NCQA), these measures are standardized quality of care indicators used to compare health plans and providers across the nation. The rates are published and are publicly available. Benchmarks are also available at a state and national level. This report provides the benchmark to the most appropriately comparable group of plans. Data Collection Methodology The HEDIS data collection process requires two distinct data collection methods. The first method for data collection is purely administrative or admin. This method uses the plan s encounter and claim data and lab results. Fourteen of the Medi-Cal measures or submeasures are defined as administrative only by NCQA, meaning that there is a high likelihood that good information on compliance can be gained from those data alone. The other measures require medical record review to supplement the administrative data. The first method, an administrative methodology, is quick and relatively inexpensive. The second method for data collection, medical record review, is a manual process requiring trained staff. This method provides data that is frequently more clinical in nature and more detailed than what the administrative data captures. Most of the measures require medical 2017 Annual HEDIS Report Page 5 of 28

6 record review in addition to use of administrative data. Measures using both sources are referred to as hybrid. Data Completeness and Limitations We did not have a repeat of suspected missing Kaiser data, as with last year. A few measures do seem suspicious, and we are investigating. We had an excellent group of chart auditors this year, and we were able to pursue almost all of the data chases. Performance Evaluation of Product Lines The software, processes, and accuracy of data are audited by NCQA-accredited outside firms for Medi-Cal (State required and Accreditation required) and Medicare measures. The results of each performance evaluation are submitted to state and federal authorities. Each group of measures passed their audits. The following are the organizations that require HEDIS audits and have the HEDIS measure results reported to them: 1. Contra Costa County Human Resources for Commercial Plans for Employees 2. California Department of Health Care Services (DHCS) for Medi-Cal 3. Center for Medicare and Medicaid Services (CMS) for Medicare 4. NCQA for our Accreditation Internally, the data are reviewed and results are prioritized by the Quality Director and staff, the Medical Director, the CEO, Clinical Leadership Group, and the Quality Council. The annual report is also presented to the Joint Conference Committee, CCHP s governing body Annual HEDIS Report Page 6 of 28

7 Commercial Plans for County Employees The commercial plans, known as Plan A and Plan B, offer employees a choice to either use the CCRMC Network (Plan A) or use CCRMC and/or CPN networks (Plan B). Measures are reported to Contra Costa County Human Resources. At the end of 2016, we were serving about 8,0 members in this plan. The benchmark presented is the national average for commercial plans. Three of the four measures are above the national mean performance level. The asthma measure will be addressed by a performance improvement project. Commercial Plans for County Employees Performance Rates HEDIS Score: CCHP County Benefits MEASURES National mean AMM- Antidepressant Med. Mgmt., acute phase AMR-Asthma Medication Ratio URI- Appropriate Treatment for children with URI CHL- Chlamydia screening Annual HEDIS Report Page 7 of 28

8 Medicare The red shading indicates measures below the mean. Tan is those that did not improve. Ten of the thirteen are below the national Medicare HMO mean, and only four improved from last year. Two of these measures will be addressed by the next round of improvement projects Annual HEDIS Report Page 8 of 28

9 Medi-Cal The CCHP Medi-Cal product line is the State Medicaid program in California. This is by far CCHP s largest product, serving around 185,000 members at the end of 2016 or more than % of our membership. Measures are reported to the state s Department of Health Care Services (DHCS). This year, CCHP improved on 15 of the Medi-Cal measures; performance declined on 4, and 5 were new and do not have comparatives. One was unchanged. 13 of the 18 measures with a Medi-Cal mean scored above the Medi-Cal mean. This year, we have 4 measures above the national Medicaid th percentile (High Performance Level or HPL): Avoidance of Antibiotics for Bronchitis, Timely Prenatal Care, Timely Postpartum Care, and Physical Activity Counseling for Children and Adolescents. We have 1 measure below the national Medicaid 25 th percentile (Minimum Performance level or MPL): Nephropathy Screen or Treatment for Diabetics. Several measures improved by more than 10%. Postpartum improved 11% (7.3 percentage points). (The prenatal rate improved by 6%.) Diabetic A1c greater than 9 improved 23% (10 percentage points), and A1c less than 8 improved 11%. Avoidance of Antibiotics in Acute Bronchitis improved 13%. The readmission rate improved by 10%. There were no double digit declines. The only ones that dropped were: Well Visits 3-6 Years, 8%; Avoidance of Imaging for Low Back Pain, 7%; Retinal Eye Exam for Diabetics, 6%; and Nephropathy screen/treat for Diabetics, 1% Annual HEDIS Report Page 9 of 28

10 Medi-Cal Performance Charts (the mean displayed is the 2016 Medi-Cal HMO mean) Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) The percentage of members 3-17 years old, continuously enrolled with no more than a one month gap in coverage, who had at least one outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year: 1) Counseling for nutrition, and 2) Counseling for physical activity or referral for physical activity counseling. These measures have improved over the years, thanks in part to our Pediatric Obesity Program. The Physical Activity measure is now above the national th percentile WCC Nutrition counseling WCC Nutrition Counseling 2016 Mean Nutrition counseling WCC Activity Counseling WCC Physical activity counseling Mean Physical activity counseling Annual HEDIS Report Page 10 of 28

11 Well Child Visits in the Third, Fourth, Fifth, and Sixth years of Life (W34) The percentage of Medi-Cal members who turned three, four, five, or six years of age, and continuously enrolled during the measurement year who received one or more well visits with a primary care provider in during the measurement year. The compliance rate for this measure has decreased for two year, but it is still above the mean. W W Mean Childhood Immunizations Status (CIS) Combo 3 The percentage of children continuously enrolled 12 months prior to the child s second birthday, who had four DTaP/DT, three IPV, one MMR, three H influenza type B, three hepatitis B, one chicken pox vaccine (VZV) and four pneumococcal conjugate by their second birthday. There was improvement this period after a decline in the prior year. CIS Combo CIS Combo Mean Annual HEDIS Report Page 11 of 28

12 Timeliness of Prenatal Care (PPC- Pre) This is the percentage of deliveries that received a prenatal care visit in the first trimester or within 42 days of enrollment in the health plan. Continuous enrollment requirement is 43 days prior to delivery through 56 days after delivery. This measure has improved in the last couple of years and is now above the national Medicaid th percentile. PPC Pre PPC Pre Mean Postpartum Care (PPC-Post) This is the percentage of deliveries that had a postpartum visit on or between days after delivery. (3-8 weeks postpartum). This measure has improved in the last couple of years, thanks in part to our performance improvement project and is now above the national Medicaid th percentile. PPC Post PPC Post Mean Annual HEDIS Report Page 12 of 28

13 Cervical Cancer Screening (CCS) The percentage of women years of age continuously enrolled for the measurement year, who received one or more pap tests during the measurement year or the two years prior to the measurement year (3-year span). Or for those 30 and above, the interval can be extended to five years if there is HPV co-testing. This measure has seen small improvement over the last three years after falling significantly. CCS CCS Mean Avoidance of Antibiotic Treatment for Adults with Acute Bronchitis (AAB) The percentage of adults years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription on or within three days after the episode date. A higher rate is better. We continue to do well with this measure. It is above the th percentile. AAB AAB Mean Annual HEDIS Report Page 13 of 28

14 Comprehensive Diabetes Care (CDC) This set of six indicators measure process and outcome related to the care of patients aged with type 1 and type 2 diabetes, continually enrolled for the measurement year. Retinal Eye Exam- A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year or a negative retinal exam performed in the year prior to the measurement year. There was a decrease the last two years, bringing this measure below the mean. CDC Diabetes Eye Exam 2 Yrs CDC Diabetes Eye Exam 2 yrs Mean Eye Exam 2 Yrs Annual HEDIS Report Page 14 of 28

15 Nephropathy screening- Screening for nephropathy or evidence of nephropathy or nephropathy treatment in the medical record. This measure requires annual screening regardless of past results. Member can be made compliant by evidence of treatment of nephropathy, an encounter with a Nephrologist, a urine microalbumin test in the measurement year, or evidence of ACEI/ARB therapy. We had always done well on this measure, including performaing above the th percentile last year, but the performance levels jumped five points this year, leaving us below the 25 th percentile. CDC Nephrophathy Screening CDC Diabetes Nephropathy screen or treatment 2016 Mean Nephropathy screening HbA1c Testing- One or more HbA1c tests performed during the measurement year with a result documented in the medical record. This mesure showed good improvement this year across all networks Annual HEDIS Report Page 15 of 28

16 CDC Diabetes HbA1c Testing CDC Diabetes HbA1c testing Mean HbA1c testing HbA1c Level-Two rates are measured: >9%, where a lower score is better, and <8%, where a higher score is better. If there is no record of the test in the measurement year, it is counted against us in the >9% rate. Good movement in both rates this year. CDC Diabetes HbA1c (>9%) (Lower is better) CDC Diabetes HbA1c(>9%) low is better 2016 Mean HbA1c (>9%) low is better Annual HEDIS Report Page 16 of 28

17 CDC Diabetes HbA1c (<8%) CDC Diabetes HbA1c (<8%) Mean Diabetes HbA1c (<8%) Blood Pressure < 140/- The most recent outpatient reading. Both systolic and diastolic rates must be below the standards to pass. If there is no reading on record for the measurement year, the case counts against us. This measure improved. CDC Diabetes BP<140/ CDC Diabetes BP <140/ Mean Diabetes BP<140/ Annual HEDIS Report Page 17 of 28

18 Lower Back Pain (LBP) The percentage of adult members 18- years, with no gaps in enrollment, who had an outpatient encounter with a primary diagnosis of lower back pain who did not have an imaging study within 28 days of the diagnosis. This measure has been falling for three years and is now below the mean. LBP LBP Mean Immunization for Adolescents (IMA) Combination 2 Rate The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday. As of this year, HPV is required as well. Since this is a significant change, there is no comparative or history. The rate is 27.93% Annual HEDIS Report Page 18 of 28

19 Controlling High Blood Pressure (CBP) The percentage of members years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/) during the measurement year. This measure had a small improvement after a large drop last year from an anomalously high rate in A Performance Improvement Project (PIP) will be launched this year to improve the rate of blood pressure control. The PIP will focus on African Americans, who as a group scored 18 points below the total sample and 26 points below the highest scoring racial group. CBP CBP Mean Annual Monitoring for Patients on Persistent Medications (MPM) The percentage of members 18 years of age and older who received at least 1 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. There are two measures: Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). Annual monitoring for members on diuretics. MPM (ACE or ARB) measure has varied little and is slightly higher than the mean Annual HEDIS Report Page 19 of 28

20 MPM ACE or ARB MPM ACE or ARB Mean ACE/ARB MPM (Diuretics) measure had a small increase in the last two years. MPM Diuretics MPM Diuretics Mean Diuretics Annual HEDIS Report Page 20 of 28

21 All-Cause Readmissions (ACR) For members 21 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an acute readmission for any diagnosis within 30 days. This measure has fluctuated widely; it improved by one and a half points (10%) this year. PCR (lower is PCR Annual HEDIS Report Page 21 of 28

22 Additional Measures for Accreditation These measures are required for maintaining our NCQA Accreditation. They are not required by the Medi-Cal program, so California comparisons are not available. We are above the mean on 23 of 32 measures Annual HEDIS Report Page 22 of 28

23 Stratifications of the Medi-Cal Data and Disparities Identified Comparison of Care Networks CCHP Medi Cal HEDIS Measures 2017 CCHP 2017 RMC WCC Nutrition counseling given for children 72.93% 75.47% 56.64%.74% Physical activity counseling for children 71.71% 76.10% 52.45%.74% W34 *Yearly well child visit 3 6 yr % 71.02% 63.09% 87.95% CIS *Combo 3 immunizations 76.67% 78.33% 65.93% 89.77% PPC *First trimester prenatal 91.24% 92.79% 89.69% 89.13% Postpartum visit days 75.43% 75.68% 64.95% 85.87% LBP Avoiding Use of Imaging for Low Back Pain 76.18% 75.74% 73.10% 79.22% BCS Breast Cancer Screening % 58.29% 46.18% 84.76% CCS *Cervical cancer screening 58.48% 53.31% 51.81%.49% Diabetes Eye Exam 2 yrs % 45.55% 48.10% 75.00% *Diabetes HbA1c testing.91% 89.32% 93.67% 97.22% CDC Diabetes HbA1c(>9%) (lower is better) 31.82% 30.25% 41.77% 22.22% Diabetes HbA1c (<8%) 55.56% 54.45%.63% 75.00% Diabetes Nephropathy screen or treatment 88.13% 87.% 86.08% 94.44% Diabetes BP <140/ 63.13% 61.21% 64.56% 75.00% AAB Avoidance of Antibiotics in Adults With Acute Bronchitis 46.% 45.19% 41.35% 68.13% IMA 2 Immunizations for Adolescents: Combo % 23.20% 26.14% 37.00% AMR Asthma Medication Ratio % 31.77% 40.28% 86.95% CBP *Controlling High Blood Pressure 58.87% 59.47% 45.65%.00% CDF Screening for Depression and follow up Screening 18.03% Screening for Depression and follow up Follow Up.00% All Cause Readmissions (lower is better) 13.95% 14.22% 12.56% 0.00% ACR All Cause Readmission, SPDs 17.22% 17.75% 15.34% 0.00% All Cause Readmission, Non SPDs 11.03% 11.42% 9.20% 0.00% Monitoring for Patients on persistent Medications MPM ACE or ARB 88.54% 88.11% 86.83% 92.72% Monitoring for Patients on persistent Medications Diuretics 87.39% 87.35% 83.64% 91.08% AMB CAP 2017 CPN 2017 KSR Ambulatory Care Outpatient Visits per 0 Member Months Ambulatory Care Emergency Department Visits per 0 Member Months Children and Adolescents' Access to Primary Care Practitioners Months % 93.58% 91.39% 97.72% 2017 Annual HEDIS Report Page 23 of 28

24 Children and Adolescents' Access to Primary Care Practitioners 25 Months 6 Years % 81.11% 77.49% 87.45% Children and Adolescents' Access to Primary Care Practitioners 7 11 Years % 82.44% 83.34% 91.55% Children and Adolescents' Access to Primary Care Practitioners Years 2.84% 78.65% 75.%.14% *included in default algorithm Above th Percentile Below 25 th Percentile CCRMC saw their average measure improve by 3 percentage points. They have four rates above the national th percentile: Physical Activity Counseling, Timely Prenatal Care, Timely Postpartum care, and Avoidance of Antibiotics in Adults with Acute Bronchitis. The rate for Nephropathy Screening or Treatment for Diabetics was below the Minimum Performance Level established by DHCS. Well Visits 3 rd to 6 th Years and Eye Exams for Diabetics both decreased significantly, but there were big improvements in Timely Prenatal Care, Avoidance of Antibiotics, and Readmission. The Community Provider Network was below the Minimum Performance Level on 6 (improved from 9 last year) of the 22 measures. The average measure improved by almost 6 points. A1c Testing is above the th percentile and A1c Control improved dramatically. Kaiser is the highest scoring network on most measures. Suspected incomplete data from them make one measure questionable. They were above the High Performance Level (National Medicaid th percentile) on 16 measures and were below the Minimum Performance Level (National Medicaid 25 th percentile) on none. There was a large improvement in A1c control. Disparities Identified Through Stratification by Ethnicity All Medi-Cal measures were stratified by ethnicity. The rates for those categories with 30 or more members were compared to the total population's rate for each measure using the z- test for proportions, with alpha set at.05, to determine statistical significance Annual HEDIS Report Page 24 of 28

25 Measures collected using the administrative-only method offer the best opportunity to identify disparities because we can study the entire population, whereas hybrid measures are based on a sample. The statistical tests of hybrid measures are less able to detect statistically significant disparities due to smaller sample size: statistical tests have less power with a smaller sample size. The same statistical methodology was used with these measures as with the administrative-only measures. We are pleased to note that the African American statistical disparity in Timely Postpartum Care that was eliminated last year has not reappeared this year. None of the other statistically significant differences this year are repeated from last year. We generally only focus on measures that are disparate two years in a row. An exception this year is the African American disparity in Controlling Blood Pressure. We have decided to combat this disparity as part of our new PIP (Performance Improvement Project) on Hypertension. These findings and calculations specific to CCRMC have been shared with the Health Equity Team. All findings will be shared with Community Providers, the Quality Council, CCRMC s Patient Safety and Performance Improvement Committee and our governing body, the Joint Conference Committee Annual HEDIS Report Page 25 of 28

26 CCHP Medi Cal HEDIS Measures 2017 White Black or African American Hispanic/Latino Asian Total AAB ACR AMR BCS CBP CCS Avoidance of Antibiotics in Adults With Acute Bronchitis Denominator Reported Rate 39.34% 57.07% 49.53% 37.74% 46.% Plan All Cause Readmissions (PCR) Denominator Reported Rate 15.57% 14.% 12.82% 11.27% 13.95% Asthma Medication Ratio Denominator Reported Rate 41.% 43.94% 49.43% 41.97% 46.73% Breast Cancer Screening Denominator Reported Rate 52.86% 57.38% 64.47% 61.88% 58.96% Controlling High Blood Pressure Denominator Reported Rate 63.55% 45.57% 58.06% 67.44% 58.87% *Cervical cancer screening Denominator Reported Rate.00% 56.63% 68.87% 62.26% 58.48% Diabetes Eye Exam 2 yrs. Denominator Reported Rate 39.53%.00% 49.31% 54.05% 48.74% *Diabetes HbA1c testing Denominator Reported Rate 88.37% 93.33%.97% 93.24%.91% CDC Diabetes HbA1c(>9%) (lower is better) Denominator Reported Rate 33.72% 28.33% 39.58% 18.92% 31.82% Diabetes HbA1c (<8%) Denominator Reported Rate 59.30% 58.33% 46.53% 63.51% 55.56% Diabetes Nephropathy screen or treatment Denominator Reported Rate 87.21% 93.33%.28% 85.14% 88.13% Diabetes BP <140/ Denominator Reported Rate.47% 58.33% 72.92% 55.41% 63.13% CIS IMA LBP *Combo 3 early childhood immunizations Denominator Reported Rate 72.34% 73.91% 77.% 78.57% 76.67% Immunizations for Adolescents (IMA) Combo 2 Denominator Reported Rate 26.53% 15.69% 31.55% 35.48% 27.93% Avoiding Use of Imaging for Low Back Pain Denominator Reported Rate 73.43% 77.69% 76.% 76.02% 76.18% 2017 Annual HEDIS Report Page 26 of 28

27 MPM PPC Annual Monitoring for members on Persistent meds (ACE) Denominator 1,857 1,372 1,964 1,566 7,545 Reported Rate 87.78% 87.03%.33% 88.76% 88.54% Annual Monitoring for members on Persistent meds (Diuretics) Denominator 1,396 1,423 1, ,211 Reported Rate 87.39% 84.75%.45% 87.16% 87.39% *First trimester prenatal Denominator Reported Rate 85.33% 91.30% 96.05% 86.67% 91.24% Postpartum visit days Denominator Reported Rate 74.67% 66.67% 78.53% 82.22% 75.43% BMI %ile calculated for children Denominator Reported Rate 76.19%.95% 87.84% 66.67% 83.% WCC Nutrition counseling given for children Denominator Reported Rate 73.81% 71.43%.41% 46.67% 77.53% Physical activity counseling for children Denominator Reported Rate 69.05% 71.43% 77.% 46.67% 74.91% W34 *Yearly well child visit 3 6 yr. Denominator Reported Rate 67.27% 61.54% 75.25% 68.00% 71.57% Statistically lower than whole sample Statistically higher than whole sample Prioritization of Measures for Improvement Focus areas for the past year included Performance Improvement Projects (PIPs) in asthma and in perinatal care. Perinatal measures are now above the th percentile. The asthma HEDIS measure changed so we do not have a comparable rate. The rate for the new measure, however, is quite low. The most powerful intervention from the PIP has not yet been put into place. These PIPs are winding down and will soon be replaced by PIPs on Nephropathy Screening/Treatment for Diabetics and Controlling High Blood Pressure, with a special focus on the disparately low performance for the African American population. Through our Disease Management program, Diabetes and Childhood Obesity are also focus areas. One of the measures related to childhood obesity (WCC-Physical Activity Counseling) is now above the th percentile. Among the diabetes (CDC) measures two declined: 2017 Annual HEDIS Report Page 27 of 28

28 Nephropathy and Eye Exams, and the rest improved, especially A1c testing and control. CCHP has recently initiated outreach that may help measures reflecting care for Cervical Cancer Screening and breast Cancer Screening. These programs will continue, and we may add additional chronic condition programs when building a new Population Health Management program Annual HEDIS Report Page 28 of 28