2018 Commercial HMO/POS HEDIS 1 Results
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1 08 Commercial HMO/POS HEDIS Results Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents HEDIS 06 CY 05 HEDIS 07 CY 06 HEDIS 08 CY 07 Compass BMI Percentile 70.47% 75.8% th (6%) Counseling for Nutrition 63.49% 69.0% th (7%) Counseling for Physical Activity 56.98% 59.86% th (6%) Well-Child Visits in the First 5 Months of Life 6 or more visits 85.93% 84.7% 86.73% 75 th (87.39%) Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life 8.6% 8.33% 83.68% Maintain 90 th (88.47%) Adolescent Well-Care Visits 44.77% 46.8% 48.9% 75 th (55.74%) Combo 8.87% 85.38% 90.7% 90 th (88%) Childhood Immunization Status Combo % 8.60% 89.03% Maintain 90 th (86.75%) Combo % 58.47% 66.33% 90 th (65%) Adolescent Immunization Status Combo N/A.53% 9.% 90 th (%) Human Papillomavirus Vaccine (HPV).% 4.39%.4% 50 th (4.8%) Appropriate Treatment for Children with URI 88.75% 86.33% 89.0% 50 th (90%) Appropriate Testing for Children with Pharyngitis 89.6% 90.7% 93.55% 90 th (93%) Adult BMI Assessment 88.4% 86.08% 9.79% 90 th (9%) Breast Cancer Screening 76.9% 77.04% 77.6% 90 th (80%) Cervical Cancer Screening 76.76% 76.66% 78.03% 75 th (77%) Chlamydia Screening in Women 47.94% 48.70% 48.8% 75 th (5%) Colorectal Cancer Screening 67.49% 67.0% 73.77% 90 th (7%) Controlling High Blood Pressure 6.96% 56.3% 59.75% 75 th (65%) Persistence of Beta-Blocker Treatment After a Heart Attack 90.07% 86.36% 87.40% 50 th (89%) Retinal Exam 58.55% 7.04% 7.3% 90th (68%) HbAc Screening Rate 9.8% 9.00% 90.% 90th (94%) HbAc > 9.0% ** 6.0% 4.64% 6.55% 90th (%) HbAc < 8.0% 6.4% 64.% 64.8% 90th (65%) Monitoring for Nephropathy 89.64% 9.3% 89.55% 90th (93%) BP Control < 40/ % 6.80% 63.4% 75th (69%) Asthma Ratio Total 8.44 % 84.0% 83.99% 90% (84%) Management for People With Asthma 75 % 48.7% 5.73% 55.% 75 th (56%) Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 5.5% 7.8% 4.80% 50 th (5%) Systemic Corticosteroid 75.6% 8.9% 77.89% 90 th (8%) Bronchodilator 84.3% 84.5% 78.39% 75 th (84%) Timeliness of Prenatal Care 88.5% 89.57% 9.58% 90 th (95.6%) Postpartum Care 85.44% 84.35% 8.0% 90 th (88%) Follow-Up After Hospitalization for Mental Illness 7 Day 46.55% 58.73% 5.3% 50 th (5%) 30 Day 66.55% 80.50% 74.9% 75 th (77.4%) Acute Phase 65.3% 68.70% 69.60% 50 th (70%) Continuation 50.43% 5.37% 53.8% 50 th (54%) Initiation and Engagement of Alcohol and Other Engagement of AOD Drug Dependence Treatment Treatment: Total 9.67 % 8.65%.55% 5 th (3%) Initiation Phase 40.68% 3.9% 35.5% 5 (37%) Continuation and 48.98% 36.75% 40.57% 50 Maintenance Phase (45%) Use of Imaging Studies for Low Back Pain ** 68.00% 68.67% 68.47% 5 th (70%) Flu Vaccinations (Adults 8 64) 5.7% 56.8% 65.6% 90 th (59%) Spirometry Testing in Assessment and Diagnosis of COPD 4.87% 43.30% 45.54% 90 th (50%) Statin Therapy for Patients with Cardiovascular Statin Therapy for Patients with Diabetes Received Statin Therapy 80.43% 78.56% 83.8% 90 th (86%) Statin Adherence 80% 87.4% 66.5% 69.6% 50 th (73%) Received Statin Therapy N/A 6.30% 6.99% 75 th (63%) Statin Adherence 80% N/A 65.53% 65.06% 50 th (69%)
2 08 Medicaid HEDIS 3 Results Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents HEDIS 06 CY 05 HEDIS 07 CY 06 HEDIS 08 CY 07 Compass 3 BMI Percentile 54.76% 60.88% 6.77% 75 th (68%) Counseling for Nutrition 5.44% 57.8% 54.6% 5 th (59%) Counseling for Physical Activity 4.69% 45.37% 4.36% 5 th (49%) Combo 76.39% 76.39% 7.78% 75 th (79%) ± Childhood Immunization Status Combo % 7.9% 69.0% 50 th (79.34%) ± Combo % 36.57% 37.3% 75 th (40%) Adolescent Immunization Status Combo N/A 4.8% 8.% 90 th (30%) Human Papillomavirus Vaccine (HPV) 6.90% 7.3% 9.93% 75 th (30.66%) Well-Child Visits in the First 5 Months of Life 6 or more visits 67.76% 67.53% 66.39% 5 th (74.5%) ± Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life 74.7% 80.47% 78.89% 50 th (79.4%) ± Adolescent Well-Care Visits 44.44% 48.84% 47.0% 50 th (47.89%) Appropriate Treatment for Children with URI 87.03% 85.4% 85.5% 5 th (86%) Appropriate Testing for Children with Pharyngitis 73.55% 77.6% 87.6% 90 th (88%) Adult BMI Assessment 83.5% 85.3% 85.84% 50 th (86%) Breast Cancer Screening 54.9% 54.55% 54.4% 50 th (59%) Cervical Cancer Screening 65.80% 56.85% 66.7% 75 th (64%) Chlamydia Screening in Women 50.99% 53.77% 55.75% 50 th (57%) Controlling High Blood Pressure 5.39% 53.0% 56.59% 50 th (57%) Retinal Exam Rate 48.84% 53.94% 5.3% 50th (55%) HbAc Screening Rate 89.35% 86.8% 83.45% 75th (90%) HbAc > 9.0% (Poor Control) 37.50% 4.3% 47.45% 50th (4%) HbAc < 8.0% 5.55% 49.77% 45.50% 50th (49%) Monitoring for Nephropathy 90.74% 90.05% 88.3% 75th (9%) BP Control < 40/ % 5.55% 56.0% 50th (6%) Adherence to Antipsychotic s for Individuals with Schizophrenia (SAA) 69.5% 70.87% 66.4% 90 th (70.9%) Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic (SSD) 75.% 74.9% 7.64% 5th (77%) Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD) 7.73% 75.85% 80.% ± Cardiovascular Monitoring for People with Cardiovascular and Schizophrenia (SMC) 80.00% 9.8% 84.38% ± Management for People with Asthma 75 % 3.45% 34.4% 34.40% 75 th (4%) Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 8.50%.69% 9.80% 75 th (34%) Systemic Corticosteroid 76.34% 77.65% 76.77% 90 th (78%) Bronchodilator 89.69%* 87.34% 86.7% 90 th (88%) Timeliness of Prenatal Care 8.7% 83.0% 79.75% 50 th (83%) Postpartum Care 59.03% 60.4% 57.97% 5 th (60%) Follow-Up After Hospitalization for Mental Illness 7 Day 30.4% 38.37% 38.0% 50 th (46%) 30 Day 53.58% 63.03% 60.65% 5 th (6.97%) Acute Phase 48.80% 49.78% 48.54% 5 th (5%) Continuation 35.40% 35.7% 34.60% 50 th (36%) Initiation Phase 38.77% 39.8% 4.36% 50 th (45% ) Continuation and 47.76% 57.75% 56.84% 75 th (64%) Initiation and Engagement of AOD Dependence Engagement Maintenance of Phase AOD 9.5% 0.00% 4.8% 75th (6%) Treatment Flu vaccination for Adults Treatment: Total 44.6% 43.4% 34.5% 50th (39%) Use of Imaging Studies for Low Back Pain 68.7% 70.83% 68.6% 50 th (70%) Spirometry Testing in Assessment and Diagnosis of COPD 30.93% 7.84% 33.4% 50 th (30%) Persistence of Beta Blockers after a Heart Attack 9.8% 89.09% 88.06% 75 th (90%) Statin Therapy for Patients with Cardiovascular Received Statin Therapy N/A 76.05% 75.78% 50 th (76%) Statin Adherence 80% N/A 59.6% 6.40% 75 th (67%) Statin Therapy for Patients with Diabetes Received Statin Therapy N/A 6.40% 64.74% 90 th (68%) Statin Adherence 80% N/A 65.86% 6.65% 75 th (65%) Lead Screening 77.50% 77.8% 7.38% ± (NR) Not reported ± Medicaid Quality Compass rate not available till October
3 08 Medicare HEDIS 4 Results HEDIS 06 CY 05 HEDIS 07 CY 06 HEDIS 08 CY 07 Compass 5 Adult BMI Assessment 00% 99.05% 00.00% Maintain 90% (99%) Breast Cancer Screening 89.89% 85.84% 84.34% Maintain 90% (83%) Osteoporosis Management in Women after a Fracture 0.00%.% 0.00% 5 th (9%) Colorectal Cancer Screening 9.9% 84.5% 86.03% 90 th (8%) Controlling High Blood Pressure 84.4%% 8.57% 78.40% 90 th (84%) Persistence of Beta-Blocker Treatment After a Heart Attack 00.00% 66.67% 83.33% 5 th (89%) Statin Therapy for Patients with Cardiovascular Received Statin Therapy 70.73% 65.9% 80.77% 90 th (84%) Statin Adherence 80% 00.00% 67.4% 66.67% 5 th (7%) Retinal Exam Rate 78.50% 96.57% 93.46% 90th (83%) HbAc Screening Rate 96.6% 95.0% 95.95% 90th (97%) HbAc > 9.0%** 5.89%.46% 8.38% 75th (5%) HbAc < 8.0% 76.64% 75.39% 73.5% 90th (76%) Monitoring for Nephropathy 96.6% 97.5% 97.5% 90th (98%) BP Control < 40/ % 74.45% 7.90% 90th (80%) Systemic Corticosteroid 80.00% 6.36% 83.93% 90 th (79%) Bronchodilator 90.00% 65.9% 9.86% 90 th (88%) Follow-Up After Hospitalization for Mental 7 Day 69.3% 68.00% 50.00% 90 th (56%) Illness 30 Day 84.6% 80.00% 65.00% 90 th (70.6%) Antidepressant Management Acute Phase 70.59% 77.59% 70.00% 50 th (7%) Continuation 7.9% 60.34% 58.57% 75 th (6%) Flu Vaccinations (Adults 65 +) 80.% 7.9% 80.5% 90th (80%) Rheumatoid Arthritis Management 95.00% 8.4% 85.00% 5 th (85.9%) Potentially Harmful Drug- Interactions in the Elderly ± Total 38.98% ± 37.50%± 40.9%± 50 th (40%) ± Use of High-Risk s in the Elderly± One Prescription.64% ±.8%±.70%± 5 th (5%) ± Spirometry Testing in Assessment & Diagnosis of COPD N/A 66.67% 54.84% 90% (48%) Pneumococcal Vaccination Status for Older Adults 83.6% 85.5% NR Maintain 90% (85%) Statin Therapy for Patients with Diabetes Received Statin Therapy N/A 70.8% 70.0% 75 th (73%) Statin Adherence 80% N/A 74.9% 67.45% 5 th (70%) ± Inverted Rate Baseline measurement year NR Not Reported
4 08 Marketplace HEDIS 6 Results Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents HEDIS 06 CY 05 HEDIS 07 CY 06 HEDIS 08 CY 07 NCQA and Quality Compass 7 BMI Percentile 6.7% 68.00% 68.3% 75 th (73%) Counseling for Nutrition 58.56% 6.0% 60.58% 50 th (66%) Counseling for Physical Activity 50.69% 5.3% 5.80% 5 th (55%) Adult BMI 83.33% 8.35% 88.46% 90 th (9%) Appropriate Treatment for Children with URI 94.3% 87.66% 87.0% 50 th (90%) Appropriate Testing for Children with Pharyngitis 83.3% 88.80% 9.% 75 th (9%) Breast Cancer Screening 7.43% 68.00% % 50 th (7%) Cervical Cancer Screening 5.78% 65.40% 6.50% 5 th (7%) Chlamydia Screening in Women 46.48% 5.86% 49.7% 75 th (5%) Colorectal Cancer Screening 53.0% 5.74% 65.69% 90 th (7%) Retinal Exam Rate 4.8% 6.8% 64.96% 90th (69%) HbAc Screening Rate 90.5% 90.8% 93.9% 90th (94%) HbAc < 8.0% 58.56% 5.6% 6.77% 90th (65%) Monitoring for Nephropathy 87.73% 88.66% 87.35% 75th (9%) Management for People with Asthma 75 % 46.5 % 56.34% 6.7% Maintain 90 th (57%) Controlling High Blood Pressure 49.65% 5.3% 6.46% 75 h (65%) Follow-Up After Hospitalization for Mental Illness 7 Day 34.53% 54.55% 54.46% 75 th (56%) Initiation Phase 38.77% 39.8% (45%) Continuation and Maintenance 47.76% 50% 0% 5 Phase (40%) Acute Phase 64.94% 60.58% 67.68% 50 th (70%) Continuation 53.8% 50.9% 53.44% 50 th (54%) Timeliness of Prenatal Care 89.89% 88.0% 94.3% 90 th (95.6%) Postpartum Care 75.8% 74.48% 78.86% 75 th (8%) Well-Child Visits in the First 5 Months of Life 6 or more visits N/A 80.70% 90.9% 90 th (88.33%) Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life 78.6% 78.98% 80.34% 75 th (8.7%) Use of Imaging Studies for Low Back Pain ** 70.90% 70.40% 68.% 5 th (70%) Childhood Immunizations Combo % 8.54% 78.6% 75 th (84.68%) Adolescent Immunization Status Combo N/A.% 33.33% 90 th (%) Human Papillomavirus Vaccine (HPV) 6.9% 3.33% 33.33% 90 th (36.5%) Flu Vaccinations (Adults) 46.6% 5.0% 47.4% 50th (50%) Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis.4% 9.48% 5.37% 75 th (30%) For more information about Quality Improvement at Optima Health please see the Provider Reference Manual or contact the Quality Improvement Department at or For more information regarding NCQA visit their web site at ncqa.org.
5 08 survey results Commercial HMO/POS Adult Survey Getting Needed Care 87.4% 87.4% 88.% Getting Care Quickly 85.9% 87.4% 87.8% 96.0% 96.% 96.8% Customer Service 88.3% 9.% 89% Health Promotion and Education 76.5% 79.0% 77.% Rating of Health Care 77.5% 76.8% 8.% Rating of Personal Doctor 84.6% 87.5% 77.4% Rating Specialist 8.9% 85.9% 68.9% Rating of Health Plan 6.0% 60.% 59.4% Flu Shot Adults Ages % 56.8% 65.6% 74.6% 70.7% 7.4% Medicaid HMO Adult Survey Getting Needed Care 79.8% % Getting Care Quickly 83.% 8.5% 8.% 88.6% 90.9% 90.7% Customer Service 87.4% 87.3% 9.4% Health Promotion and Education 7.6% 73.5% 75.% Rating of Health Care 76.% 76.5% 74% Rating of Personal Doctor 8.6% 8.0% 65.% Rating Specialist 79.9% 8.6% 63.% Rating of Health Plan 80.5% 8.4% 6% Flu Shot Adults Ages % 43.4% 34.5% 80.7% 86.9% 67.7% Medicare Adult Survey Getting Needed Care 86.7% 84.5% 84.4% Getting Care Quickly 78.5% 77.0% 78.% 93.3% 9.% 9.4% Customer Service 89.0% 9.7% 89.6% Care Coordination 90.% 89.0% 85.8% Getting Needed Prescription Drugs*** 9.% 88.7% 89.% Rating of Drug Plan 86.9% 84.% 84.3% Rating of Health Care 87.6% 86.7% 85% Rating of Personal Doctor 9.9% 9.% 9.% Rating Specialist 89.9% 90.8% 88.5% Rating of Health Plan 86.% 85.6% 85% Annual Flu Shot 8.% 7.9% 80.5% Marketplace Experience Survey Access to Care 78.6% 88.0% 79.% Getting Care Quickly 79.8% 86.0% 78.3% Getting Needed Care 89.4% 89.3% 80.% Care Coordination 86.9% 87.9% 85.8% 95.% 95.% 89.9% Rating of Health Care 86.6% 87.5% 84.% Rating of Health Plan 69.0% 74.% 8.8% Rating of Personal Doctor 89.9% 89.7% 89.0% Rating Specialist 86.3% 9.0% 89.7% Plan Administration 84.% 8.4% 8.4% Annual Flu Shot 46.6% 5.0% 47.4% 55.6% 64.% 85.7% For more information about Quality Improvement at Optima Health, please see the Provider s Reference Manual or contact the Quality Improvement Department at For more information regarding NCQA visit their website at ncqa.org. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)
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