A set of annually reported standardized performance measures developed by NCQA and utilized by over 90% of America's health plans to assess Quality.
What is HEDIS
100
This measure newly added the 3-dose HPV vaccine
What is IMA or Immunizations for Adolescents
100
Measures women who had a live birth delivery and met the criteria for timeliness and postpartum care
What is Prenatal and Postpartum Care or PPC
100
The following are acceptable confirmation diagnoses for which measure:
1. Hyperpiesis
2. Intermittent HTN
3. Elevated BP
4. History of HTN
What is CBP or Controlling Blood Pressure
100
Controlling Blood Pressure
What is C B P
200
Effectiveness of Care
Access/Availability of Care
Experience of Care
Utilization and Risk Adjusted Utilization
Relative Resource Use
Health Plan Descriptive Information
Measures collected using electronic clinical data systems
Are all examples of what
What is Domains of Care
200
This measure requires annual therapeutic monitoring for members either on an ACE inhibitor, ARB, Digoxin, or a Diuretic
What is MPM or Annual Monitoring for Patients on Persistent Medications
200
Measures women who have received a mammogram to screen for breast cancer during the measurement year or two (2) years prior
What is Breast Cancer Screening or BCS
200
How far back can you search the history of women ages 30-64 who had a cervical cytology/HPV co-testing
What is 5 years
200
Childhood Immunization Status
What is C I S
300
This type of measure requires reviewing claims, encounter, supplemental data and medical record documentation to validate if members received the services or care being measured
What is Hybrid measures
300
DTap, MMR, Hep B, Hib, IPV are examples of vaccinations used for which measure
What is CIS or Childhood Immunizations
300
Measures adolescent members who had an outpatient visit with a PCP or OB/Gyn and had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity
What is Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
300
Women with non-live births are the exclusion for which measure
What is PPC or Prenatal and Post-partum Care
300
Ambulatory Care
What is A M B
400
Gold Coast Health Plan conducts medical record over-reads for what percentage of compliant records
What is 100%
400
This measure requires documentation of all of the following in order to be compliant:
1. Health hx
2. Physical Development hx
3. Mental Development hx
4. Physical exam
5. Health education/anticipatory guidance
6. Date of service
What is W34 or Well Child
400
Measures members who have been screened for Clinical Depression and had their encounter documented on an age-appropriate standardized screening tool and if positive received a plan for follow-up documented on the encounter
What is Screening for Clinical Depression and Follow-Up Plan or CDF
400
Which childhood measure requires the documentation of either the BMI percentile or BMI percentile plotted on an age-growth chart
What is WCC or Weight Assessment and Counseling for Children and Adolescents
400
Use of Imaging Studies for Low Back Pain
What is L B P
500
The name of the current GCHP HEDIS vendor
What is Inovalon
500
Documentation of any of the following indicates compliance for which measure and subpart:
1. Documentation of a visit to a nephrologist
2. Documentation of a renal transplant
3. Urine test for albumin or protein
What is CDC - medical attention to nephropathy
500
Measures adolescent members who received age appropriate vaccines before their 13th birthday during the measurement year
What is Immunizations for Adolescents or IMA
500
School-based clinics with practitioners the health plan considers PCPs are considered compliant services that documentation may be considered for this measure