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Neighborhood Health Plan of Rhode Island

HEDIS? 2005: Overview. OverviewHEDIS stands for Health Plan Employer Data and Information Set. It is the most widely used standardized set of performance measures in the managed care industry. HEDIS development and maintenance is sponsored and supported by the National Committee for Quality Assu

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Neighborhood Health Plan of Rhode Island

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    5. HEDIS 2005 Results: Childhood Immunization Status Description: The percentage of children who turned two years old during 2003 and were up-to-date with immunizations. NHPRI results: 4 DTP (diphtheria-tetanus-pertussis) 86% 3 OPV/IPV (oral or injectable polio virus) 95%. 1 MMR (measles-mumps-rubella) 94%. 3 Hib (haemophilus influenza type B) 83%. 3 Hep B (hepatitis B) 89%. 1 VZV (chicken pox) 91%. Combo 1: 70%. (all required DPT, OPV, HIB, MMR, HEP B) Combo 2: (combo 1 and VZV) 68% NHPRIs rate ranked above the 75th percentile. Rotated Measure

    6. HEDIS 2005 Results: Adolescent Immunization Status Description: The percentage of members who turned 13 during 2003 and were up-to-date with immunizations. NHPRI results: 1 MMR (measles-mumps-rubella) 90% 3 Hep B (hepatitis B) 76% 1 VZV (chicken pox) 77% Combo 1 (MMR and Hep B) 76% Combo 2 (all immunizations) 67% NHPRIs rate ranked above the 90th percentile. Rotated Measure

    8. HEDIS 2005 Results: Cervical Cancer Screening Description: The percentage of women 21-64 years old, who received one or more Pap tests during the three year period 2002 - 2004. NHPRIs rate ranked above the 90th percentile.

    9. HEDIS 2005 Results: Appropriate Treatment For Children With Upper Respiratory Infection Description: The percentage of children 3 months to 18 years of age who were diagnosed with upper respiratory infection and were not dispensed an antibiotic prescription on or 3 days after the Episode Date.

    10. HEDIS 2005 Results: Appropriate Testing For Children With Pharyngitis Description: The percentage of children 2 18 years of age who were diagnosed with pharyngitis, prescribed an antibiotic and who received a group A streptococcus test for the episode.

    11. HEDIS 2005 Results: Chlamydia Screening in Women Description: The percentage of women age 16 through 25 years identified as sexually active, who had at least one test for chlamydia during 2004. NHPRIs rate ranked close to the 50th percentile in the ages 16-20 category and the 21-26 category.

    13. HEDIS 2005 Results: Comprehensive Diabetes Care Description: The percentage of members with diabetes age 18 through 75 years old, who had each of the following during 2004: Hemoglobin A1c (HbA1c) tested HbA1c well controlled (<9.0%) LDL-C Control (LDL <130 mg/dL) LDL-C Control (LDL <100 mg/dL) Dilated eye exam performed Lipid profile performed Kidney disease monitored

    14. HEDIS 2005 Results: Use of Appropriate Medications for People with Asthma Description: This process measure evaluates whether members, age 5 through 56 with persistent asthma are being prescribed medication acceptable as primary therapy for long-term control of asthma. process measure evaluates NHPRIs rate ranked above the 90th percentile in the 5-9 & 10-17 age groups and combined rates. The 18-56 age group rate ranked above the 75th percentile.

    15. HEDIS 2005 Results: Follow-Up After Hospitalization for Mental Illness Description: The percentage of members age 6 and older who were hospitalized for treatment of selected mental health disorders and were seen on an ambulatory basis or were in day/night treatment with a mental health practitioner within 7 days and within 30 days of discharge.

    16. HEDIS 2005 Results: Antidepressant Medication Management Description: The percentage of members age 18 years and older as of April 30, 2004 who were diagnosed with a new episode of depression, treated with antidepressant medication, and: 1) had at least 3 follow-up contacts with a PCP or mental health PCP during the 84-day Acute Treatment Phase (Contacts); 2) remained on an antidepressant drug during the entire 84-day Acute Treatment Phase (Effective Acute Phase Treatment); 3) remained on an antidepressant drug for at least 180 days (Effective Continuation Phase Treatment). NHPRIs rate ranked above the 50th percentile in practitioner contacts, acute phase treatment rate and the continuation phase treatment.

    17. HEDIS 2005 Results: Medical Assistance with Smoking Cessation Advising Smokers to Quit Description: This rate is calculated using combined responses from the HEDIS 2004 and 2005 CAHPS 3.0H Adult Medicaid survey. It measures the percent of current smokers or recent quitters, seen by a health plan provider, who received advice to quit smoking from a health plan provider. NHPRIs rate ranked above the 75th percentile.

    18. Description: This rate is calculated using combined responses from the HEDIS 2004 and 2005 CAHPS 3.0H Adult Medicaid survey. It measures the percent of current smokers or recent quitters, seen by a health plan provider, whose practitioner recommended or discussed smoking cessation medications.

    19. Description: This rate is calculated using combined responses from the HEDIS 2004 and 2005 CAHPS 3.0H Adult Medicaid survey. It measures the percent of current smokers or recent quitters, seen by a health plan provider, whose practitioner recommended or discussed smoking cessation methods or strategies. HEDIS 2005 Results: Medical Assistance with Smoking Cessation - Discussing Smoking Cessation Strategies

    20. HEDIS 2005 Results: Adults Access to Preventive/Ambulatory Health Services Description: The percentage of enrollees age 20 and older, who have had an ambulatory or preventive care visit during 2004. NHPRIs rate ranked close to the 90th percentile in all of the age categories.

    21. HEDIS 2005 Results: Childrens Access to Primary Care Practitioners Description: The percentage of enrollees between 12 months and 19 years of age who have had a visit with a health plan primary care practitioner (PCP) during 2004. NHPRIs rate ranked above the 90th percentile for ages 12 months through 11 years.

    22. HEDIS 2005 Results: Claims Timeliness Description: The percentage of all claims received by the MCO or its claims processing centers, from January 1, 2004 December 1, 2004, that were paid or denied within 30 calendar days of receipt.

    23. HEDIS 2005 Results: Call Abandonment Description: The percentage of calls received by the MCO member services call centers during 2004 that were abandoned by the caller before being answered by a live voice.

    24. HEDIS 2005 Results: Well-Child Visits in the First 15 Months of Life Description: The percentage of enrollees who turned 15 months old during 2003, and who received either zero, one, two, three, four, five, or six or more well-child visits with a PCP during their first 15 months of life. A child should be included in only one numerator.

    25. HEDIS 2005 Results: Well-Child Visits Third to Sixth Year of Life Description: The percentage of enrollees who turned three, four, five, or six years old during 2004 and who received one or more well-child visit(s) with a PCP during 2004. NHPRIs rate ranked above the 90th percentile.

    26. HEDIS 2005 Results: Adolescent Well-Care Visits Description: The percentage of enrollees who were age 12 through 21 years during 2004 and who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during 2004. NHPRIs rate ranked above the 90th percentile.

    27. HEDIS 2005 Results: Consumer Assessment of Health Plans Survey Mail survey that measures the health care experience of randomly selected Medicaid adults (age 18 years or older), continuously enrolled for at least six months. Available in English and Spanish. Survey conducted by an NCQA-certified vendor, The Myers Group 1,755 members randomly selected for the survey, and 545 members responded (33%).

    28. HEDIS 2005 Results: CAHPS Summary

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