| | Gundersen Lutheran Health Plan Medicare HEDIS Clinical Quality Measures 2006
Purpose
To measure Gundersen Lutheran Health Plan performance in the HEDIS clinical quality measures for our Senior Preferred population.
Background
HEDIS (Health Plan Employer Data and Information Set) 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. HEDIS is part of an integrated system to establish accountability in managed care.
HEDIS measures are divided into eight general areas or domains, one of which is the "Effectiveness of Care" domain. This domain provides important information about the quality of the clinical care provided by the health plan (1).
Gundersen Lutheran Health Plan has been reporting HEDIS measures for its Senior Preferred Medicare population since reporting year 2000. The Center for Medicare and Medicaid Services (CMS) requires that Managed Care Organizations (MCOs) report on performance measures from the HEDIS reporting set relevant to the Medicare managed care population.
Aim
Gundersen Lutheran Health Plan’s performance will be comparable to or exceed reported benchmarks.
Method/Measures
The measurement population consists of Gundersen Lutheran Health Plan Senior Preferred members. Providers of care to these members consist of 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. Three of the Effectiveness of Care measure (Flu Shots for Older Adults, Pneumonia Vaccination Status and Advising Smokers to Quit) are collected via the CAHPS® survey. Detailed specifications for these measures are contained in the 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. Follow-up After Hospitalization for Mental Illness and Advising Smokers to Quit are the only measures not reportable for our Senior Preferred population, due to a denominator of less than 30.
Healthcare Research Associates conducted a full HEDIS Compliance Audit on our Medicare HEDIS report, and determined that we accurately measured the HEDIS indicators according to the NCQA HEDIS technical specifications.
Benchmarks
NCQA 2005 National Medicare averages were used for comparison except for Flu Shots, Pneumonia Vaccination Status and Advising Smokers to Quit where CMS State Averages were used. (CMS 2005 benchmarks not yet available).
Results
| MEASURE | 2005 GL Health Plan | 2005 NCQA
National Avg |
| STAYING HEALTHY |  | |
| Breast Cancer Screening | 84.0% | 71.6%s |
| Colorectal Cancer Screening | 67.9% | 53.9%s |
| Glaucoma Screening | 58.7% | 61.6%s |
| Flu Shots | 81.0% | 80.0%* |
| Pneumonia Vaccination Status | 78.0% | 77.0%* |
| CARDIOVASCULAR CARE | | |
| Beta Blocker Treatment after MI | 100% | 93.8% |
| Controlling High Blood Pressure | 69.3% | 66.4% |
| DIABETES CARE | | |
| HbA1c Performed | 94.9% | 88.9%s |
| HbA1c Controlled (9.0% or less) | 91.5% | 76.4%s |
| Eye Exam Performed | 85.2% | 66.5%s |
| LDL-C Screening | 97.6% | 93.3%s |
| LDL-C Controlled (<130 mg/dL) | 83.7% | 71.6%s |
| LDL-C Controlled (<100 mg/dL) | 64.5% | 50.0%s |
| Screening or Presence of Nephropathy | 74.9% | 60.2%s |
| SMOKING CESSATION | | |
| Advising Smokers to Quit | 91.0%~ | 64.7%** |
| RESPIRATORY CARE | | |
| Use of Spirometry Testing In The Diagnosis of COPD | 33.1% | 26.3%s |
| BEHAVIORAL HEALTH CARE | | |
| 30 day Follow-up After Hospitalization for Mental Illness | 72.2%~ | 59.3% |
| 7 day Follow-up After Hospitalization for Mental Illness | 44.4%~ | 39.1% |
*CMS 2005 WI Average * * CMS 2004 WI Average
~ Denominator less than 30 S – significantly different from the GLHP rate (p < .05)
Links to Graphic Displays of Data
Staying Healthy
Cardiovascular
Diabetes
Smoking Cessation
Respiratory Care
Conclusions
1. Gundersen Lutheran Health Plan’s 2005 rates are significantly better (p < .05) than the 2005 NCQA National Medicare Average in the following HEDIS clinical quality measures: Breast Cancer Screening, Colorectal Cancer Screening, Flu Shots, Pneumonia Vaccination, Diabetes Care (HbA1c Screening, HbA1c Control, Eye exam, LDL Screening, LDL Control <130, LDL Control <100, Nephropathy), and Use of Spirometry Testing in the Diagnosis of COPD.
2. Gundersen Lutheran Health Plan’s 2005 rates were significantly below (p < .05) the 2005 NCQA National Medicare Averages for Glaucoma Screening.
Next Steps
1. Collaborate with Gundersen Lutheran Medical Center to develop interventions for their Colorectal Cancer Screening initiative.
2. Promote LDL-C Screening through our Diabetes Disease Management Program.
3. Consider development of a promotion to increase the Glaucoma Screening Rate.
References
1. National Committee for Quality Assurance, HEDIS® 2005, 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, State of Health Care Quality, 2006.
5. Medicare Managed Care CAHPS® 2004 Survey Results, Issued by the Centers for Medicare & Medicaid Services in 2006.
Activity Leader
Charles Schauberger, MD; Annette Kastenschmidt, RN
Acknowledgements
Andy Kyser, RN; Doua Xiong; Jeff Falk
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality. |