| | Gundersen Lutheran Health Plan Commercial HEDIS Clinical Quality Measures 2006
Purpose
To measure Gundersen Lutheran Health Plan’s performance in the HEDIS clinical quality measures for our Commercial fully insured HMO (Health Maintenance Organization) population.
Background
HEDIS® 2006 (based on 2005 Health Plan membership) is the latest edition of the Health Plan Employer Data and Information Set. It is the most widely used set of standardized performance measures in the managed care industry. HEDIS® is developed and maintained by the National Committee for Quality Assurance (NCQA), a not-for-profit organization committed to assessing, reporting on, and improving the quality of care provided by organized delivery systems.
A number of HEDIS measures provide important information about the quality of the clinical care provided by the health plan. Some measures look at how well an MCO (Managed Care Organization) delivers preventive services, keeping its members healthy. Other measures look at whether the most up-to-date treatments are being offered to treat acute episodes of illness, helping members get better. Finally, a third aim of this group of measures is to look at the care delivered to those with chronic disease, to see how well an MCO’s health care delivery system helps members cope with their illness (1). Gundersen Lutheran Health Plan has been assessing performance using the HEDIS® measurements since 1996.
Aim
Gundersen Lutheran Health Plan’s performance will be comparable to or exceed reported benchmarks.
Method/Measures
Beginning with HEDIS® 2000, our measurement population includes members of only our Commercial fully insured HMO groups (self-funded and point of service groups are excluded). Providers of care to these members include the entire Gundersen Lutheran system, and a number of non-Gundersen Lutheran providers who participate in the health plan network by contractual agreement. HEDIS® results for a given year are based on the previous years Health Plan membership. For example, HEDIS® 2006 results are based on 2005 Health Plan membership.
Specific inclusion and exclusion criteria are established for each HEDIS measure. Two of the Effectiveness of Care measures – Medical Assistance with Smoking Cessation, and Flu Shots – are collected via the CAHPS® survey. Detailed specifications for these measures are available in HEDIS Volume 3, Specifications for Survey Measures (2). All other measure specifications are detailed in HEDIS Volume 2, Technical Specifications (3). HEDIS specifications state that each measure must have a denominator of at least 30 in order to be reportable. Gundersen Lutheran Health Plan had 2 measures with a denominator less than 30—Beta Blocker After a Heart Attack and Persistence of Beta Blocker Treatment After a Heart Attack.
To decrease the workload of reporting HEDIS measures, NCQA designates certain measures that can be rotated off each year. This means that an MCO can choose not to measure the designated indicator for that particular measurement year. If the MCO does rotate a measure, they then report the same rate for that measure two years in a row. Gundersen Lutheran Health Plan did rotate off Cervical Cancer Screening and Prenatal/Postpartum Care for the 2005 reporting year.
The Health Plan Information Systems Department programs and produces the results for our HEDIS measures. Healthcare Research Associates, an audit firm licensed by NCQA to conduct HEDIS compliance audits, audits the programming source code and our methods for measuring the HEDIS indicators. All of our Commercial Clinical Quality Measures were determined to be reportable.
Benchmark
The data presented are compared to the Wisconsin HMO average, and the national HMO average as reported in NCQA’s Quality Compass 2006 (4).
Results
MEASURE | 2005 Gundersen Lutheran Health PLan | 2005 WI HMO Avg | 2005 National HMO Avg |
CHILD & ADOLESCENT CARE |  | | |
Childhood Immunization Combination
(4 DTP, 3 OPV, MMR, 3 HEP B, 3 HIB, VZV) | 82.4% | 87.3% | 77.3% |
| Childhood Chicken Pox Vaccine | 91.8% | 93.1% | 89.7% |
Adolescent Immunization Combination
(2nd MMR, 3 HEP B, VZV) | 61.6% | 65.7% | 51.1%s |
| Adolescent MMR Booster | 88.6% | 87.6% | 77.2%s |
| Treatment for Children with URI | 90.6% | 88.2% | 82.9%s |
| Testing for Children with Pharyngitis | 71.1% | 77.9% | 66.9% |
STAYING HEALTHY | | | |
| Adults’ Flu Shot (age 50-64)* | 44.0% | 47.6% | 38.7%s |
| Breast Cancer Screening | 78.3% | 79.2% | 72.3%s |
| Cervical Cancer Screening | 86.6%~ | 86.9% | 80.7% |
| Chlamydia Screening | 38.6% | 37.1% | 37.5% |
| Colorectal Cancer Screening | 55.0% | 61.6%s | 49.7%s |
CARDIOVASCULAR | | | |
| Controlling High Blood Pressure | 75.2% | 72.2% | 67.3%s |
| Beta Blocker Treatment After a Heart Attack | 100.0%** | NA | 95.6% |
| Persistence of Beta Blocker Treatment After a Heart Attack | 90.0%** | NA | 71.5% |
GETTING BETTER | | | |
| Appropriate Medications for Asthma^ | 89.8% | 92.5% | 89.8% |
| Use of Imaging Studies for Low Back Pain | 70.9% | 75.1% | 76.2% |
DIABETES | | | |
| HbA1c Performed | 91.7% | 93.7% | 87.3%s |
| HbA1c Controlled (9.0% or less) | 81.8% | 82.7% | 69.3%s |
| Eye Exam Performed^ | 75.2% | 74.7% | 54.9%s |
| LDL-C Test Performed | 93.2% | 95.5%s | 92.1% |
| LDL-C Controlled (<130 mg/dL) | 74.2% | 78.4%s | 67.0%s |
| LDL-C Controlled (<100 mg/dL) | 52.6% | 53.6% | 42.9%s |
| Screening or Presence of Nephropathy | 71.3% | 68.9% | 57.5%s |
MATERNITY CARE | | | |
| Prenatal Care in 1st Trimester | 97.1%~ | 93.4% | 90.2% |
| Check-ups After Delivery | 89.6%~ | 84.8% | 80.1% |
BEHAVIORAL HEALTH CARE | | | |
| 30-day FU after Hospitalization for Mental Illness | 73.1% | 81.5% | 75.6% |
| 7-day FU after Hospitalization for Mental Illness | 32.7% | 56.3%s | 55.0%s |
| Antidepressant Med Mngmt (3+ FU contacts during 84 days) | 17.7% | 21.8% | 18.8% |
| Antidepressant Management (on meds entire 84 days) | 60.4% | 66.8% | 60.6% |
| Antidepressant Management (on meds entire 180 days) | 44.8% | 50.6% | 44.5% |
MEDICAL ASSISTANCE WITH SMOKING CESSATION | | | |
| Advising Smokers to Quit* | 72.9% | 70.5% | 71.4% |
| Discussed Medications to Assist Smoking Cessation* | 48.1% | 43.2% | 39.2%s |
| Discussed Other Strategies to Assist Smoking Cessation* | 52.0% | 42.9% | 39.7%s |
~ Measure rotated—this is the 2004 rate
NA-Rate not available
S – significantly different from the Gundersen Lutheran Health Plan rate (p < .05)
* Rolling average methodology used; results & benchmarks calculated using both CAHPS 2004 and 2005 data
^ Measure specifications changed, see graphic display for details
**Denominator less than 30.
Links to Graphic Displays of Data
Child and Adolescent Care
Staying Healthy
Cardiovascular
Getting Better
Diabetes
Maternity Care
Behavioral Health
Medical Assistance with Smoking Cessation
Conclusions
1. Gundersen Lutheran Health Plan’s 2005 rates are significantly better (p < .05) than the 2005 National HMO Average in the following HEDIS clinical quality measures: Childhood Immunization (Polio, Hepatitis B), Adolescent Immunizations (MMR, Hepatitis B, Chicken Pox), Treatment for Children with URI, Colorectal Cancer Screening, Breast Cancer Screening, Controlling Hypertension, Diabetes Care (HbA1c Screening, HbA1c Control, Eye exam, LDL Control <130, LDL Control <100, Nephropathy), Advising Smokers to Quit by Recommending Medications, Advising smokers to Quit by Recommending other Strategies, and Flu Shots. Gundersen Lutheran Health Plan’s rates were significantly below (p < .05) the National HMO Average for the Follow up after Hospitalization for Mental Illness-7 days. For the rest of the rates, Gundersen Lutheran Health Plan is similar to the national HMO averages.
2. Gundersen Lutheran Health Plan’s 2005 rates were similar to the Wisconsin HMO averages for a majority of the measures. Areas in which Gundersen Lutheran Health Plan rates were significantly below (p < .05) the Wisconsin HMO averages include: Childhood Immunizations-DTaP, Colorectal Cancer Screening, Diabetes Care-LDL screening, Diabetes Care-LDL Control <130, and Follow up after Hospitalization for Mental Illness-7 days.
Next Steps
1. Forward Antidepressant Medication Management and Follow up After Hospitalization for Mental Illness performance results and benchmarks to the Gundersen Lutheran Behavioral Health Department. Collaborate with that department on a plan for improving these rates.
2. A provider from Gundersen Lutheran Behavioral Health will join Gundersen Lutheran Health Plan’s QI Subcommittee.
3. Send reminder to parents of members turning 18 months old regarding immunization requirements for 2 year olds.
4. Collaborate with Gundersen Lutheran Medical Center to develop interventions to improve Colorectal Cancer Screening rate.
5. Focus on improvement of LDL-C screening with our diabetes disease management program.
References
1. National Committee for Quality Assurance, HEDIS® 2006, Volume 1, Narrative.
2. National Committee for Quality Assurance, HEDIS 2006, Volume 3, Specifications for Survey Measures.
3. National Committee for Quality Assurance, HEDIS® 2006, Volume 2, Technical Specifications.
4. National Committee for Quality Assurance, Quality Compass 2006.
Leader
Charles Schauberger, MD; Annette Kastenschmidt, RN
Acknowledgments
Andy Kyser, RN; Doua Xiong, Jeff Falk
The source for data contained in this publication is Quality Compass2006 and is used with the permission of the National Committee for Quality Assurance (NCQA). Any analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation, or conclusion. Quality Compass and HEDIS® are registered trademarks of the National Committee for Quality Assurance.
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality. |