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The Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used set of performance measures in the managed care industry. HEDIS helps your patients compare how managed care plans perform in the areas they care about.
Developed by the National Committee for Quality Assurance (NCQA), HEDIS is one part of a larger system that establishes accountability in health care and complements the NCQA accreditation program.
Highmark annually gathers HEDIS data on Commercial PPO, Medicare Advantage PPO, and Children’s Health Insurance Program (CHIP) GPPO members for:
To help practitioners improve their “effectiveness of care” measures, Highmark continues to support clinical advisory committees. Network physicians from internal medicine, family practice, endocrinology, cardiology, geriatrics, women’s health, pulmonary, pediatrics, infection control, and behavioral health, among others, serve on these committees. These committees review the annual HEDIS results, along with other pertinent data, to determine clinical quality improvement opportunities.
Here is a subset of the HEDIS measures. This will provide you with a comparison based on services received in the 2016 measurement year (MY 2016) for the HEDIS 2017 reporting year (RY) as compared to the 2017 national averages. We also have provided 2015 measurement year (MY 2015) results for additional comparison.
Important Note: The source of the National Average data contained in this publication is from either Quality Compass® 2017 or The State of Healthcare Quality 2017 and is used with the permission of the NCQA. Quality Compass 2017 includes certain CAHPS® data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. The Medicare Health Outcomes Survey results are released on CMS Health Plan Management System (HPMS).
Commercial PPO |
MY 2016 |
MY 2015 |
2017 PPO |
Prevention and Screening |
|||
Adult BMI Assessment |
83.39% |
75.72% |
62.90% |
Weight Assessment, Nutritional Counseling and Physical Activity for Children/Adolescents |
|||
BMI Percentile Total |
64.48% |
56.45% |
51.99% |
Counseling for Nutrition Total |
61.56% |
54.50% |
49.99% |
Counseling for Physical Activity Total |
56.45% |
51.82% |
44.89% |
Childhood Immunizations |
|||
Combo 2 - DTaP, Polio, MMR, HepB, Hib + VZV |
83.45% |
73.97% |
69.56% |
Breast Cancer Screening |
69.87% |
69.49% |
70.16% |
Cervical Cancer Screening |
68.13% |
68.71% |
72.96% |
Colorectal Cancer Screening |
67.01% |
62.59% |
58.31% |
Chlamydia Screening |
|||
Combined Rate |
43.32% |
40.92% |
44.93% |
Respiratory Conditions |
|||
Appropriate Testing of Children with Pharyngitis |
85.89% |
84.47% |
83.28% |
Use of Spirometry Testing in Assessment and DX of COPD |
37.95% |
39.87% |
40.46% |
Pharmacotherapy Management of COPD Exacerbation |
|||
Systemic Corticosteroid |
69.33% |
78.34% |
69.09% |
Bronchodilator |
73.83% |
81.98% |
75.04% |
Cardiovascular Conditions |
|||
Controlling High Blood Pressure |
65.36% |
55.10% |
54.51% |
Persistence of Beta Blocker Treatment after a Heart Attack |
89.08% |
88.30% |
83.76% |
Diabetes |
|||
Hemoglobin A1c (HbA1c) Testing |
89.77% |
89.05% |
89.30% |
HbA1c Poor Control (>9.0%)* |
233.57% |
236.50% |
42.53% |
HbA1c Control (<8.0%) |
54.04% |
51.64% |
46.62% |
HbA1c Good Control (<7.0%) |
35.04% |
30.66% |
34.49% |
Diabetic Retinal Eye Exam |
55.66% |
53.83% |
47.55% |
Nephropathy Screening |
87.79% |
87.23% |
88.08% |
Blood Pressure Control (<140/90mm Hg) |
62.12% |
57.85% |
50.47% |
Behavioral Health |
|||
Antidepressant Medication Management |
|||
Acute Phase Treatment |
67.66% |
67.60% |
67.87% |
Continuation Phase Treatment |
50.88% |
51.63% |
52.62% |
Follow-Up Care For Children Prescribed ADHD Medication |
|||
Initiation Phase |
49.02% |
48.33% |
39.02% |
Continuation/Maintenance Phase |
59.34% |
56.53% |
45.84% |
Follow-up After Hospitalization for Mental Illness |
|||
7 day |
48.64% |
48.48% |
50.42% |
Overuse/Appropriateness |
|||
Appropriate Treatment of Children with URI (inverted rate) |
84.37% |
85.76% |
87.01% |
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis* |
226.62% |
223.65% |
27.04% |
Use of Imaging Studies for Low Back Pain |
71.35% |
74.99% |
74.31% |
Access/Availability of Care |
|||
Prenatal and Postpartum Care |
|||
Timeliness of Prenatal Care |
80.56% |
86.56% |
76.37% |
Checkups After Delivery |
76.94% |
68.20% |
65.94% |
CAHPS® |
|||
Flu Shots for Adults Ages 18-64 |
46.00% |
45.58% |
47.06% |
*2Lower rates are better for this measure.
Medicare Advantage PPO |
MY 2016 |
MY 2015 |
2017 |
Prevention and Screening |
|||
Adult BMI Assessment |
98.33% |
93.88% |
91.79% |
Breast Cancer Screening |
74.62% |
76.06% |
72.49% |
Colorectal Cancer Screening |
81.03% |
70.40% |
69.77% |
Respiratory Conditions |
|||
Use of Spirometry Testing in Assessment & Testing of COPD |
33.79% |
37.24% |
35.03% |
Pharmacotherapy Management of COPD Exacerbation |
|||
Systemic Corticosteroid |
62.42% |
76.82% |
68.62% |
Bronchodilator |
67.17% |
73.23% |
74.06% |
Cardiovascular Conditions |
|||
Controlling High Blood Pressure |
78.81% |
69.23% |
69.66% |
Persistence of Beta Blocker After Heart Attack |
93.57% |
95.39% |
89.86% |
Diabetes |
|||
Comprehensive Diabetes Care |
|||
Hemoglobin A1c (HbA1c) testing |
95.58% |
92.09% |
93.62% |
HbA1c Poor Control >9.0%* |
15.23% |
28.83% |
23.34% |
HbA1c Control <8.0 |
71.99% |
55.36% |
66.28% |
Diabetic Retinal Eye Exam |
74.94% |
76.53% |
69.60% |
Nephropathy Screening |
95.58% |
95.66% |
95.33% |
Blood Pressure Control <140/90 |
75.92% |
57.65% |
60.56% |
Musculoskeletal Conditions |
|||
Osteoporosis Management in Women Who Had a Fracture |
28.08% |
25.14% |
34.16% |
Behavioral Health |
|||
Antidepressant Medication Management |
|||
Acute Phase Treatment |
74.62% |
73.57% |
73.24% |
Continuation Phase Treatment |
61.13% |
60.10% |
59.45% |
Follow-up After Hospitalization for Mental Illness |
|||
7 day |
39.33% |
37.62% |
35.40% |
Medication Management |
|||
Annual Monitoring for Patients on Persistent Medications |
|||
Total |
92.01% |
92.06% |
91.90% |
Use of High-Risk Medications in the Elderly |
|||
One Prescription* |
215.79% |
211.57% |
12.55% |
At Least Two Prescriptions* |
210.08% |
21.38% |
8.56% |
CAHPS® |
|||
Flu Shots for Older Adults |
75% |
78.00% |
73% |
Pneumonia Vaccination for Older Adults |
80% |
82.00% |
73% |
*2Lower rates are better for this measure.
Children’s Health Insurance Program (CHIP) GPPO |
MY 2016 |
MY 2015 |
2017 |
Prevention and Screening |
|||
Weight Assessment and Counseling for Nutrition |
|||
BMI Percentile Total |
84.44% |
71.60% |
69.09% |
Counseling for Nutrition Total |
74.74% |
63.95% |
65.32% |
Counseling for Physical Activity Total |
67.86% |
61.98% |
57.61% |
Childhood Immunizations |
80.61% |
78.85% |
73.04% |
Immunizations for Adolescents |
|||
Meningococcal |
93.43% |
88.04% |
77.40% |
Tdap/Td |
93.19% |
91.85% |
84.85% |
Lead Screening in Children |
28.57% |
33.65% |
67.62% |
Respiratory Conditions |
|||
Appropriate Testing for Children with Pharyngitis |
85.52% |
83.89% |
74.12% |
Behavioral Health |
|||
Follow-Up Care for Children Prescribed ADHD Medications |
|||
Initiation Phase |
58.23% |
64.71% |
44.48% |
Continuation and Maintenance Phase |
NA |
NA |
54.51% |
Overuse/Appropriateness |
|||
Appropriate Treatment for Children with URI |
85.97% |
87.30% |
88.59% |
Access/Availability of Care |
|||
Children and Adolescents’ Access to PCPs |
|||
12-24 months |
100.00% |
100.00% |
94.78% |
25 months-6 years |
96.10% |
96.05% |
87.10% |
7-11 years |
97.39% |
97.20% |
89.94% |
12-19 years |
97.40% |
97.19% |
88.47% |
Annual Dental Visits 2-18 years total |
80.60% |
80.38% |
52.66% |
Use of Services |
|||
Well-Child Visits in the First 15 Months of Life 6 visits total |
85.37% |
86.11% |
61.70% |
Well-Child Visits in 3rd, 4th, 5th, and 6th Year of Life |
82.78% |
82.99% |
72.17% |
Adolescent Well-Care Visits |
65.06% |
64.35% |
50.59% |
NA — Not applicable; denominator fewer than 30
