Question

Real-World Case

Value-Based Purchasing:

Performance measures across the states’ Medicaid plans vary widely (Kuhmerker and Hartman 2007a, 13). Often these performance measures are the Health Plan Employer Data and Information Set (HEDIS®) measures or a similar set (Kuhmerker and Hartman 2007a, 8). Included in the HEDIS are measures related to immunizations, screenings, appropriate prescriptions, and preventive and follow-up care (NCQA 2007, 1-1–1-11).

Meeting or exceeding the targets or thresholds in the performance measures is thought to represent quality and results rewards or penalties. The states’ Medicaid programs have structured their financial incentives in many different ways.

Describe 2 HEDIS or CAHPS measures including how the measure works, relevant information needed, and why it is important.

Answer 1

HEDIS stands for Health care Effectiveness Data and Information developed by the National Committee for Quality Assurance(NCQA)
HEDIS measures include addressing important health issues like physical and mental health chronic conditions, newborn, child and adolescent immunization, well visit, screening, use of antibiotics, women's preventive health and pregnancy care, patient experience including when patient receives high care like rating of health plan, health care providers, health plan customer services, timeliness appointment. HEDIS measures include flu vaccination in adults, medical assistance, aspirin use.
February-April survey distributed to members and results will be reported annually in the members and providers newsletter..It is important to measure the health plan and providers performance. it providers quality initiatives, educational programs and monitors adherence to clinical practice guidelines. It builds a culture and supports the mission to build a healthy community. It also supports improving the experience of care, the health of the population, reducing the cost of health care.
HIPAA privacy rule permits a provider to disclose protected health information to a patient health plan for HEDIS. HIPAA privacy rule permitted with HEDIS data collection this needs no special patient consent.
HEDIS measures focus on prevention, data collected by claims and also the use of data sources like immunization registry, focus on making efforts on quality improvement initiatives.