HEDIS Part C and D Quality Measures 2010 to 2016

$199 / year

The dataset explains different metrics or standard of measurement for Part C and D (Medicare private health plans) reported at the contract level with less than 500 enrolled. Medicare Part C and D is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs (Health Maintenance Organization) and PPOs (Preferred Provider Organization), are known as Medicare Advantage Plans.

Complexity

The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used sets of health care SHOULD BE ONE WORD performance measure in the United States. The NCQA measurement development process has expanded the size and scope of HEDIS to include measures for physicians, Preferred Provider Organizations (PPO) and other Health Maintenance Organizations (HMO). The HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. NCQA collects HEDIS data directly from Health Plan Organizations and Preferred Provider Organizations for multiple purposes via the Healthcare Organization Questionnaire (HOQ) and HEDIS non-survey data through the Interactive Data Submission System (IDSS). National Committee for Quality Assurance (NCQA) collects Medicare HEDIS data on behalf of the Centers for Medicare & Medicaid Services (CMS), and Medicaid HEDIS data on behalf of state agencies. In addition, NCQA collects commercial data on behalf of some states and the U.S. Office of Personnel Management for health plan report cards.

The National Committee for Quality Assurance (NCQA) is an independent non-profit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. NCQA operates on a formula of measure, analyze, and improve and it aims to build consensus across the industry by working with policymakers, employers, doctors, and patients, as well as health plans. Health plans seek accreditation and measure performance through the administration and submission of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

HEDIS data collected by NCQA are important for researchers working to improve the health care system, as well as for NCQA staff seeking to improve the HEDIS measures themselves. Commercial HEDIS data are used to calculate national performance statistics and benchmarks, as well as to set standards for measures included in NCQA’s Accreditation program. Developing a measure is a multi-step process. It involves identifying the clinical area to evaluate; conducting an extensive literature review; developing the measure with the appropriate MAP and other panels; vetting it with various stakeholders; and performing a field-test that looks at feasibility, reliability and validity. NCQA consistently raises the bar. Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA’s seal of approval. These standards will promote the adoption of strategies that will improve care, enhance service and reduce costs, such as paying providers based on performance, leveraging the Web to give consumers more information, disease management and physician-level measurement. Many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans.

Date Created

2015-12-17

Last Modified

2015-12-17

Version

2015-12-17

Update Frequency

Annual

Temporal Coverage

2010 to 2014-12-31

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare & Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

CMS Star Rating, CMS Measures, CMS Quality Metrics, CMS Health Measures, CMS Performance Measures, HEDIS Tool, HEDIS Data, NCQA Measurement Process

Other Titles

HEDIS Part C and D Quality Measures CMS Star Ratings 2016, HEDIS Part C and D Quality Measures CMS 2016, HEDIS Part C Performance, Part D Performance, Part C and D Performance Quality Measures Medicare Ratings 2016, Quality Metrics HEDIS Part C and D 2016, Health Measures HEDIS Part C and D 2016, Performance Measure HEDIS Part C and D Quality Measures 2016

Name Description Type Constraints
YearPerformance Year of Part C and D (2014, 2015 and 2016)date-
Contract_NumberContract number for measurement for Part C and Dstring-
Contract_NameContract Name (Insurance Company)string-
Organization_NameOrganization Marketing Namestring-
Parent_OrganizationParent Organization of Insurance Companystring-
Organization_TypeType of Organizationstring-
FollowUp_Visit_Mental_Illness_Within_30_Days_Of_Discharge_PartCFollow up Visit after Hospital Stay for Mental Illness (within 30 days of discharge) - Part Cstring-
Call_Answer_Timeliness_Part_CCall Answer Timeliness - Part Cstring-
Antidepressant_Medication_Management_6Months_Part_CAntidepressant Medication Management (6 months) - Part Cstring-
Continuous_Beta_Blocker_Treatment_Part_CContinuous Beta Blocker Treatment - Part Cstring-
Appropriate_Monitoring_Of_Patients_Taking_Long_Term_Medications_Part_CAppropriate Monitoring of Patients Taking Long-term Medications - Part Cstring-
Osteoporosis_Testing_Part_COsteoporosis Testing - Part Cstring-
Testing_To_Confirm_Chronic_Obstructive_Pulmonary_Disease_Part_CTesting to Confirm Chronic Obstructive Pulmonary Disease - Part Cstring-
Doctors_Who_Communicate_Well_Part_CDoctors who Communicate Well - Part Cstring-
Call_Center_Beneficiary_Hold_Time_Part_CCall Center – Beneficiary Hold Time - Part Cstring-
Call_Center_Information_Accuracy_Part_CCall Center – Information Accuracy - Part Cstring-
Pneumonia_Vaccine_Part_CPneumonia Vaccine - Part Cstring-
Access_To_Primary_Care_Doctor_Visits_Part_CAccess to Primary Care Doctor Visits - Part Cstring-
Grievance_Rate_Part_CGrievance Rate - Part Cstring-
Special_Needs_Plan_Care_Management_Part_CSpecial Needs Plan (SNP) Care Management - Part Cstring-
Calls_Disconnected_When_Customer_Calls_Health_Plan_Part_CCalls Disconnected When Customer Calls Health Plan - Part Cstring-
Pharmacotherapy_Mangt_COPD_Exacerbation_Systemic_Corticosteroid_PartCPharmacotherapy Management of COPD Exacerbation – Systemic Corticosteroid - Part Cstring-
Pharmacotherapy_Management_COPD_Exacerbation_Bronchodilator_PartCPharmacotherapy Management of COPD Exacerbation – Bronchodilator - Part Cstring-
Initiation_Of_Alcohol_Or_Other_Drug_Treatment_Part_CInitiation of Alcohol or other Drug Treatment - Part Cstring-
Engagement_Of_Alcohol_Or_Other_Drug_Treatment_Part_CEngagement of Alcohol or other Drug Treatment - Part Cstring-
Reminders_For_Appointments_Part_CReminders for Appointments - Part Cstring-
Reminders_For_Immunizations_Part_CReminders for Immunizations - Part Cstring-
Reminders_For_Screening_Tests_Part_CReminders for Screening Tests - Part Cstring-
Computer_Used_During_Office_Visits_Part_CComputer Used during Office Visits - Part Cstring-
Computer_Use_By_Doctor_Helpful_Part_CComputer Use by Doctor Helpful - Part Cstring-
Computer_Use_Made_Talking_With_Doctor_Easier_Part_CComputer Use Made Talking with Doctor Easier - Part Cstring-
Improving_Bladder_Control_Part_CImproving Bladder Control - Part Cstring-
Breast_Cancer_Screening_Part_CBreast Cancer Screening - Part Cstring-
Timely_Receipt_Of_Case_Files_For_Appeals_Part_DTimely Receipt of Case Files for Appeals - Part Dstring-
Timely_Effectuation_Of_Appeals_Part_DTimely Effectuation of Appeals - Part Dstring-
Drug_Plan_Provides_Complete_Enrollment_Information_Plan_Members_PartDDrug Plan Provides Pharmacists with Up-to-Date and Complete Enrollment Information about Plan Members - Part Dstring-
Calls_Disconnected_When_Customer_Calls_Drug_Plan_Part_DCalls Disconnected When Customer Calls Drug Plan - Part Dstring-
Call_Center_Beneficiary_Hold_Time_Part_DCall Center – Beneficiary Hold Time - Part Dstring-
Call_Center_Information_Accuracy_Part_DCall Center – Information Accuracy - Part Dstring-
Drug_Drug_Interactions_Part_DDrug-Drug Interactions - Part Dstring-
Diabetes_Medication_Dosing_Part_DDiabetes Medication Dosing - Part Dstring-
Completeness_Of_Drug_Plan_Information_On_Members_Extra_Help_Part_DCompleteness of the Drug Plan's Information on Members Who Need Extra Help - Part Dstring-
Drug_Plan_Current_Information_Cost_And_Coverage_Medicare_Website_PartDDrug Plan Provides Current Information on Costs and Coverage for Medicare’s Website - Part Dstring-
MPF_Stability_Part_DMPF – Stability - Part Dstring-
Grievance_Rate_Part_DGrievance Rate - Part Dstring-
Medication_Therapy_Program_Completion_Rate_Comprehensive_Review_PartDMedication Therapy Management Program Completion Rate for Comprehensive Medication Reviews - Part Dstring-
Rate_Chronic_Use_Atypical_Antipsychotics_Elderly_Nursing_Homes_PartDRate of Chronic Use of Atypical Antipsychotics by Elderly Beneficiaries in Nursing Homes - Part Dstring-
Getting_Information_From_Drug_Plan_Part_DGetting Information from Drug Plan - Part Dstring-
Call_Center_Pharmacy_Hold_Time_Part_DCall Center – Pharmacy Hold Time - Part Dstring-
Plan_Submitted_Higher_Prices_For_Display_On_MPF_Part_DPlan Submitted Higher Prices for Display on MPF - Part Dstring-
Transition_Monitoring_Failure_Rate_Drugs_Of_Clinical_Concern_PartDTransition monitoring - failure rate for drugs within classes of clinical concern - Part Dstring-
Transition_Monitoring_Failure_Rate_For_All_Other_Drugs_Part_DTransition monitoring - failure rate for all other drugs - Part Dstring-
Reminders_To_Fill_Prescriptions_Part_DReminders to Fill prescriptions - Part Dstring-
Reminders_To_Take_Medications_Part_DReminders to Take Medications - Part Dstring-
Enrollment_Timeliness_Part_C_And_DEnrollment Timeliness - Part C&Dstring-
Grievance_Rate_Part_C_and_DGrievance Rate - Part C&Dstring-
Disenrollment_Getting_Needed_Care_Coverage_Cost_Info_PartC_And_DDisenrollment Reasons - Problems Getting Needed Care, Coverage, and Cost Information (MA-PD, MA-only) - Part C&Dstring-
Disenrollment_With_Coverage_Of_Doctors_And_Hospitals_PartC_And_DDisenrollment Reasons - Problems with Coverage of Doctors and Hospitals (MA-PD, MA-only) - Part C&Dstring-
Disenrollment_With_Prescription_Drug_Benefits_And_Coverage_PartC_And_DDisenrollment Reasons - Problems with Prescription Drug Benefits and Coverage (MA-PD, PDP) - Part C&Dstring-
Disenrollment_Reasons_Financial_PartC_And_DDisenrollment Reasons - Financial Reasons for Disenrollment (MA-PD, MA-only, PDP) - Part C&Dstring-
Disenrollment_Getting_Information_About_Prescription_Drugs_PartC_And_DDisenrollment Reasons - Problems Getting Information about Prescription Drugs (MA-PD, PDP) - Part C&Dstring-
Beneficiary_Access_And_Performance_Problems_Part_C_and_DBeneficiary Access and Performance Problems - Part C&Dstring-
YearContract_NumberContract_NameOrganization_NameParent_OrganizationOrganization_TypeFollowUp_Visit_Mental_Illness_Within_30_Days_Of_Discharge_PartCCall_Answer_Timeliness_Part_CAntidepressant_Medication_Management_6Months_Part_CContinuous_Beta_Blocker_Treatment_Part_CAppropriate_Monitoring_Of_Patients_Taking_Long_Term_Medications_Part_COsteoporosis_Testing_Part_CTesting_To_Confirm_Chronic_Obstructive_Pulmonary_Disease_Part_CDoctors_Who_Communicate_Well_Part_CCall_Center_Beneficiary_Hold_Time_Part_CCall_Center_Information_Accuracy_Part_CPneumonia_Vaccine_Part_CAccess_To_Primary_Care_Doctor_Visits_Part_CGrievance_Rate_Part_CSpecial_Needs_Plan_Care_Management_Part_CCalls_Disconnected_When_Customer_Calls_Health_Plan_Part_CPharmacotherapy_Mangt_COPD_Exacerbation_Systemic_Corticosteroid_PartCPharmacotherapy_Management_COPD_Exacerbation_Bronchodilator_PartCInitiation_Of_Alcohol_Or_Other_Drug_Treatment_Part_CEngagement_Of_Alcohol_Or_Other_Drug_Treatment_Part_CReminders_For_Appointments_Part_CReminders_For_Immunizations_Part_CReminders_For_Screening_Tests_Part_CComputer_Used_During_Office_Visits_Part_CComputer_Use_By_Doctor_Helpful_Part_CComputer_Use_Made_Talking_With_Doctor_Easier_Part_CImproving_Bladder_Control_Part_CBreast_Cancer_Screening_Part_CTimely_Receipt_Of_Case_Files_For_Appeals_Part_DTimely_Effectuation_Of_Appeals_Part_DDrug_Plan_Provides_Complete_Enrollment_Information_Plan_Members_PartDCalls_Disconnected_When_Customer_Calls_Drug_Plan_Part_DCall_Center_Beneficiary_Hold_Time_Part_DCall_Center_Information_Accuracy_Part_DDrug_Drug_Interactions_Part_DDiabetes_Medication_Dosing_Part_DCompleteness_Of_Drug_Plan_Information_On_Members_Extra_Help_Part_DDrug_Plan_Current_Information_Cost_And_Coverage_Medicare_Website_PartDMPF_Stability_Part_DGrievance_Rate_Part_DMedication_Therapy_Program_Completion_Rate_Comprehensive_Review_PartDRate_Chronic_Use_Atypical_Antipsychotics_Elderly_Nursing_Homes_PartDGetting_Information_From_Drug_Plan_Part_DCall_Center_Pharmacy_Hold_Time_Part_DPlan_Submitted_Higher_Prices_For_Display_On_MPF_Part_DTransition_Monitoring_Failure_Rate_Drugs_Of_Clinical_Concern_PartDTransition_Monitoring_Failure_Rate_For_All_Other_Drugs_Part_DReminders_To_Fill_Prescriptions_Part_DReminders_To_Take_Medications_Part_DEnrollment_Timeliness_Part_C_And_DGrievance_Rate_Part_C_and_DDisenrollment_Getting_Needed_Care_Coverage_Cost_Info_PartC_And_DDisenrollment_With_Coverage_Of_Doctors_And_Hospitals_PartC_And_DDisenrollment_With_Prescription_Drug_Benefits_And_Coverage_PartC_And_DDisenrollment_Reasons_Financial_PartC_And_DDisenrollment_Getting_Information_About_Prescription_Drugs_PartC_And_DBeneficiary_Access_And_Performance_Problems_Part_C_and_D
2011H2291NANot measuredNot measuredNot measured3.900.00Not measured
2011H3214NANot measuredNot measuredNot measured6.720.61Not measured
2011H4009NANot measuredNot measuredNot measured6.021.00Not measured
2010S2893BLUE MEDICARERXBlue MedicareRx96.5590.000.0097.620.431.54100.00
2010S5644ACCENDO INSURANCE COMPANYRxAmerica82.2382.210.8296.630.490.82100.00
2010S2505WINDSOR HEALTH PLAN, INC.Windsor Rx50.0066.670.0075.001.611.83100.00
2011H2425BLUE PLUSBlue Plus42.1177.6473.8386.67100.00100.000.0010.552.87100.00
2011H2459UCARE MINNESOTAUCare75.2269.3261.9480.75100.00100.000.005.641.44100.00
2010S5810AETNA LIFE INSURANCE COMPANYAetna Medicare83.6496.490.0096.921.302.0184.00
2011H1016AVMED, INC.AvMed Medicare48.6576.0655.7088.10100.00100.001.678.480.50100.00