Provider Bulletin August 2005 Issue
HEDIS 2005–REPORTING RESULTS
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First Priority Health’s 11th annual Health Plan Employer Data and Information Set (HEDIS®) report is
now available for your review.
The 2005 results reflect the continued progress toward achievement of our mutual goals to provide the
highest quality of care and encouragement to our members (your patients) to take an active role in their
health and well-being.
HEDIS is a set of standardized performance measures designed to ensure that purchasers and
consumers have the information they need to reliably compare the performance of managed health care
plans. Since its introduction in 1993, HEDIS has evolved to become the gold standard in managed care
performance measurement.
HEDIS is developed and maintained by the National Committee for Quality Assurance, (NCQA) an
independent, not-for-profit organization dedicated to measuring the quality of America’s health care.
The summary results from First Priority Health’s Commercial HEDIS report reflect the clinical quality
measures. These rates are derived from the eligible population enrolled in the combined HMO and POS
products. Some data are collected from the Plan’s internal claims/encounter system and, in most studies,
are supplemented by medical record reviews performed in physicians’ offices. Your cooperation, along
with assistance from your office staff, contributes significantly to our rates. Some suggestions for reducing
barriers that may be limiting patient compliance are provided to help improve the health outcomes for our
members. These recommendations are consistent with First Priority Health’s Practice Guidelines and may
cover a broader scope of performance than the HEDIS specifications.
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®
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
August 2005
Breast Cancer Screening
2005 Rate
71.85%
2004 Rate
72.62%
Recommendation:
• Actively encourage women age 40+ to have a screening mammogram.
• Annually remind women ages 50 and over who have not received a mammogram to have one.
Cervical Cancer Screening
2005 Rate
76.38%
2004 Rate
78.55%
Recommendation:
• Encourage women ages 18 and older to have an annual Pap test.
Chlamydia Screening
2005 Rate
2004 Rate
Women
Age: 16-20
19.53%
15.31%
Age: 21-25
19.45%
15.95%
Recommendation:
• Screen all sexually active women for Chlamydia in combination with annual cervical cancer screening.
Comprehensive Diabetes Care
HbA1c testing
HbA1c poor control (>9.0%)
Eye exam
LDL-C screening
LDL-C < 130 mg/Dl
LDL-C < 100 mg/Dl
Monitoring for kidney disease
Recommendation:
2005 Rate
86.73%
34.55%
48.51%
90.16%
63.62%
34.55%
40.73%
2004 Rate
85.98%
28.97%
45.29%
90.34%
60.92%
31.26%
42.76%
Provider Bulletin August 2005 Issue
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Perform HbA1c testing at least annually (glycohemoglobin is not acceptable).
Perform annual microalbuminuria screening.
Perform a fasting lipid profi le annually (request LDL-C value on lab report).
Schedule an annual eye exam to screen for diabetic retinopathy (no referral necessary).
Refer patients to First Priority Health’s Diabetes Management Program, accessible by calling toll-free,
1-866-262-4764, ext. 4414.
Controlling High Blood
2005 Rate
2004 Rate
Pressure
Blood pressure adequately
72.19%
67.41%
controlled (≤ 140/90)
Recommendation:
 Follow recommendations of the Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation and Treatment of High Blood Pressure (JNC7)
 Review current First Priority Health Practice Guidelines.
 Refer patients with comorbidities, such as diabetes or cardiovascular disease, to the appropriate FPH
health improvement program (e.g., coronary artery disease program) accessible toll-free at 1-866-2624764, ext. 4417.
Prenatal and Postpartum
2005 Rate
2004 Rate
Care
Timeliness of prenatal care
90.83%
93.33%
Recommendation:
 Encourage pregnant patients to receive appropriate prenatal care early in the first trimester.
 Refer patients to FPH’s Prenatal Program, accessible by calling toll-free 1-866-262-4764, ext. 4418.
Postpartum care
85.00%
85.45%
Recommendation:
 Remind pregnant patients and new mothers of the importance of a timely postpartum checkup.
 Schedule a postpartum visit 21-56 days after delivery.
 Document in the medical record any of the following:
- a notation of “postpartum care”;
- evaluation of weight, and blood pressure, and breasts, and abdomen;
- results of a pelvic exam.
Colorectal Cancer Screening
2005 Rate
39.67%
2004 Rate
39.39%
Recommendation:
 Prescribe one or more of the following screenings for members 50 years of age and over.
 Annual Fecal Occult Blood Test (FOBT): three consecutive samples.
 Flexible sigmoidoscopy every five years.
 Double contrast barium enema (DCBE) every five years.
 Colonoscopy every 10 years.
 Document, at minimum, the type of test, the year it was performed, and the results.
Initiation and Engagement of
2005 Rate
2004 Rate
Alcohol and Drug Dependence
(AOD) Treatment
Initiation of AOD Treatment
41.61%
46.63%
Engagement of AOD Treatment 13.78%
18.13%
Recommendation:
- Initiate treatment for members with a new diagnosis of AOD dependence through either an inpatient
AOD admission or two outpatient services for AOD within 14 days of diagnosis.
- Schedule at least two additional AOD services within 30 days after initiation of treatment.
Provider Bulletin August 2005 Issue
HEDIS rates reflect the partnership among our network providers and health plan working together to
improve the health of our members. If you or your office staff have questions or comments about HEDIS,
or recommendations to help increase the number of members receiving the appropriate care and
screenings, please feel free to contact any of the following staff members of the HEDIS Department at
First Priority Health: Rosanne O’Boyle (570) 200-4611, Cathy Branley (570) 200-4616, Carol Bender
(570) 200-4659, or Linda Emershaw (570) 200-4615.