HEDIS 2016 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 2016 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 can be found on the HEDIS page of our Provider Portal. The Provider Portal can be accessed by signing in to www.anthem.com and clicking on Provider, followed by Health and Wellness, Quality, and finally HEDIS. You will find reference documents entitled HEDIS 101 for Providers and HEDIS Documentation Guidelines. IMPORTANT NOTE: The following information pertains only to our Anthem PPO and Anthem HealthKeepers lines of business and does NOT include data about 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 Comprehensive Diabetes Care - Poor HbA1c Control (>9): Lower rate is good HEDIS 2016 Results Network Update December 2016 Page 1
HEDIS 2016 Anthem PPO and Anthem HealthKeepers Health Products Measure Name Anthem HealthKeepers PPO Effectiveness of Care Prevention and Screening Adult BMI Assessment 84.72 77.69 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - Counseling for Physical Activity Total 61.31 57.47 Childhood Immunization Status - Combo 2 81.89 79.56 Childhood Immunization Status - Combo 3 79.16 76.89 Immunizations for Adolescents - Combo 1 59.74 58.42 Human Papillomavirus Vaccine for Female Adolescents 15.87 16.79 Breast Cancer Screening Ages Total 73.17 72.93 Cervical Cancer Screening 76.70 73.99 Colorectal Cancer Screening 60.56 63.84 Chlamydia Screening in Women Total 43.40 41.23 Effectiveness of Care- Respiratory Conditions Appropriate Testing for Children With Pharyngitis 90.39 85.75 Appropriate Treatment for Children With Upper Respiratory Infection NR NR Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis NR NR Use of Spirometry Testing in the Assessment and Diagnosis of COPD 37.15 39.12 Pharmacotherapy Management of COPD Exacerbation (Corticosteroid) 74.21 70.38 Pharmacotherapy Management of COPD Exacerbation (Bronchodilator) 77.37 71.25 Effectiveness of Care- Cardiovascular Controlling High Blood Pressure 62.37 55.93 Persistence of Beta-Blocker Treatment after a Heart Attack 83.65 83.58 HEDIS 2016 Results Network Update December 2016 Page 2
Effectiveness of Care- Diabetes Comprehensive Diabetes Care - HbA1c Testing 90.63 90.75 Comprehensive Diabetes Care - Poor HbA1c Control (>9) 27.85 34.31 Comprehensive Diabetes Care HbA1C Good Control (<8) 60.51 57.42 Comprehensive Diabetes Care - Eye Exams 53.67 50.36 Comprehensive Diabetes Care - Medical attention for nephropathy 90.63 88.58 Comprehensive Diabetes Care Blood Pressure Control <140/90 70.38 63.50 Effectiveness of Care- Musculoskeletal Disease Modifying Anti-Rheumatic Drug Therapy 89.41 89.20 Imaging Studies for Low Back Pain 65.71 70.11 Effectiveness of Care- Medication Management Annual Monitoring for Patients on Persistent Medications Total 86.13 86.99 Access/Availability of Services Prenatal and Postpartum Care - Timeliness of 86.74 89.17 Prenatal Care Prenatal and Postpartum Care - Postpartum Care 82.50 75.63 Utilization and Relative Resource Use - Utilization Well Child Visits in the First Fifteen Months of Life (6+ visits) 86.80 82.33 Well Child Visits in the Third, Fourth, Fifth and Sixth Year of Life 81.05 76.29 Adolescent Well Care Visits 45.62 41.89 In Virginia, there were many rates within our Anthem PPO and Anthem HealthKeepers lines of business that improved and/or exceeded the national average: Anthem HealthKeepers lines 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 - Counseling for Physical Activity Total Childhood Immunization Status - Combo 2 Childhood Immunization Status - Combo 3 Comprehensive Diabetes Care - Medical attention for nephropathy Comprehensive Diabetes Care Blood Pressure Control <140/90 HEDIS 2016 Results Network Update December 2016 Page 3
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 Anthem HealthKeepers line of business with measure rate increases that did not meet or exceed the national average: Breast Cancer Screening Ages Total Imaging Studies for Low Back Pain Adolescent Well Care Visits Anthem HealthKeepers line of business rates that exceeded the national average but did not show improvement: Cervical Cancer Screening Controlling Blood Pressure Comprehensive Diabetes Care - HbA1c Testing Comprehensive Diabetes Care - Poor HbA1c Control (>9) Comprehensive Diabetes Care HbA1C Good Control (<8) Appropriate Testing for Children With Pharyngitis Disease Modifying Anti-Rheumatic Drug Therapy Annual Monitoring for Patients on Persistent Medications Total Prenatal and Postpartum Care - Timeliness of Prenatal Care Prenatal and Postpartum Care - Postpartum Care Anthem HealthKeepers line of business measures that showed rate decreases and have opportunities for improvement: Immunizations for Adolescents MENIN Human Papillomavirus Vaccine for Female Adolescents Colorectal Cancer Screening Pharmacotherapy Management COPD Bronchodilator Anthem HealthKeepers line of business that showed notable rate improvements in several measures including: Weight Assess/Counseling - BMI 3-11 years Weight Assess/Counseling - BMI Total Cervical Cancer Screening Annual Monitoring Persistent Meds Digoxin Anthem PPO line of business rates that were improved and exceeded 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 Human Papillomavirus Vaccine for Female Adolescents Breast Cancer Screening Ages Total HEDIS 2016 Results Network Update December 2016 Page 4
Appropriate Testing for Children With Pharyngitis Controlling High Blood Pressure Persistence of Beta-Blocker Treatment after a Heart Attack Comprehensive Diabetes Care HbA1C Good Control (<8) Comprehensive Diabetes Care - Medical attention for nephropathy Disease Modifying Anti-Rheumatic Drug Therapy Annual Monitoring for Patients on Persistent Medications Total 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 Anthem PPO line of business with measure rate increases that did not meet or exceed the national average: Use of Spirometry Testing in the Assessment and Diagnosis of COPD Adolescent Well Care Visits Anthem PPO line of business rates that exceeded the national average but did not show improvement: Adult BMI Assessment Cervical Cancer Screening Comprehensive Diabetes Care - Eye Exams Colorectal Cancer Screening Comprehensive Diabetes Care Blood Pressure Control <140/90 Anthem PPO line of business measures that showed rate decreases and have opportunities for improvement: Immunizations for Adolescents MENIN Immunizations for Adolescents - Combo 1 Colorectal Cancer Screening Pharmacotherapy Management COPD Bronchodilator Controlling High Blood Pressure Comprehensive Diabetes Care - Eye Exams Well-Child Visits in the first 15 Months of Life (1 visit) Well-Child Visits in the first 15 Months of Life (2 visits) Anthem PPO line of business that showed notable rate improvements in several measures including: Weight Assess/Counseling - Physical Activity 3-11 years Well-Child Visits in the first 15 Months of Life (0 visits) Weight Assess/Counseling - BMI 3-11 years Weight Assess/Counseling - Nutrition Counseling 12-17 years Weight Assess/Counseling - Physical Activity Total Childhood Immunization Status - Combo 10 In Virginia, many scores for Anthem HealthKeepers line of business improved and exceeded the national average, of those were Weight Assess/Counseling Physical Activity Total (10.03%); Comprehensive Diabetes Care Nephropathy (5.22%); and Childhood Immunization Status Combo 2 (2.86%). HEDIS 2016 Results Network Update December 2016 Page 5
In the Anthem PPO line of business, there were also improved scores that exceeded the national average, which were Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Counseling for Physical Activity Total (9.31%); Childhood Immunization Status Combo 2 (4.81%); Comprehensive Diabetes Care Nephropathy (5.23%); and Well Child Visits in the First 15 Months of Life (6+ visits) (2.41%). Although many rates are above the national average this year for both the Anthem PPO and Anthem HealthKeepers lines of business, there were opportunities for improvement for the measures with the most significant decreases in rates including: Anthem HealthKeepers line of business Immunizations for Adolescents MENIN ( - 7.41%); Human Papillomavirus Vaccine for Female Adolescents (- 5.48%); Colorectal Cancer Screening (- 11.02%); and Pharmacotherapy Management COPD Bronchodilator ( -7.56%). Those measures for the Anthem PPO line of business are Immunizations for Adolescents MENIN (-6.56%); Immunizations for Adolescents - Combo 1 (-5.27%); Colorectal Cancer Screening (- 8.10%); Controlling High Blood Pressure (-10.33%); and Comprehensive Diabetes Care Eye Exams (- 5.48%). We strive to improve our processes for requesting and obtaining medical records each year for our HEDIS project. Our goal is to improve our scores each year, with the assistance from you and your staff responding within the requested time frame for returning requested medical records. In addition, clear documentation of all care in the medical record, coding all claims accurately, and continuing to provide appropriate care within the designated time frame will help lead to improvement. Again, we thank you and your staff for demonstrating teamwork, as we work together to help 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 2016 Results Network Update December 2016 Page 6