Others titles
- HEDIS Part C and D Quality Measures CMS Star Ratings
- HEDIS Part C and D Quality Measures CMS
- HEDIS Part C Performance, Part D Performance, Part C and D Performance Quality Measures Medicare Ratings
- 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
Keywords
- CMS Star Rating
- CMS Measures
- CMS Quality Metrics
- CMS Health Measures
- CMS Performance Measures
- HEDIS Tool
- HEDIS Data
- NCQA Measurement Process
HEDIS Part C and D Quality Measures
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.
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Description
The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used sets of healthcare 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 healthcare 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 healthcare 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.
About this Dataset
Data Info
Date Created | 2015-12-17 |
---|---|
Last Modified | 2022-01-20 |
Version | 2022-01-13 |
Update Frequency |
Annual |
Temporal Coverage |
2021 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare & Medicaid Services; |
Source License URL | |
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, HEDIS Part C and D Quality Measures CMS, HEDIS Part C Performance, Part D Performance, Part C and D Performance Quality Measures Medicare Ratings, 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 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Contract_Number | Contract number for measurement for Part C and D | string | - |
Contract_Name | Contract Name (Insurance Company) | string | - |
Organization_Name | Organization Marketing Name | string | - |
Parent_Organization | Parent Organization of Insurance Company | string | - |
FollowUp_Visit_Mental_Illness_Within_30_Days_Of_Discharge_PartC | Follow up Visit after Hospital Stay for Mental Illness (within 30 days of discharge) - Part C | string | - |
Antidepressant_Medication_Management_6Months_Part_C | Antidepressant Medication Management (6 months) - Part C | string | - |
Continuous_Beta_Blocker_Treatment_Part_C | Continuous Beta Blocker Treatment - Part C | string | - |
Osteoporosis_Testing_Part_C | Osteoporosis Testing - Part C | string | - |
Testing_To_Confirm_Chronic_Obstructive_Pulmonary_Disease_Part_C | Testing to Confirm Chronic Obstructive Pulmonary Disease - Part C | string | - |
Doctors_Who_Communicate_Well_Part_C | Doctors who Communicate Well - Part C | string | - |
Call_Center_Beneficiary_Hold_Time_Part_C | Call Center – Beneficiary Hold Time - Part C | string | - |
Pneumonia_Vaccine_Part_C | Pneumonia Vaccine - Part C | string | - |
Access_To_Primary_Care_Doctor_Visits_Part_C | Access to Primary Care Doctor Visits - Part C | string | - |
Calls_Disconnected_When_Customer_Calls_Health_Plan_Part_C | Calls Disconnected When Customer Calls Health Plan - Part C | string | - |
Pharmacotherapy_Mangt_COPD_Exacerbation_Systemic_Corticosteroid_PartC | Pharmacotherapy Management of COPD Exacerbation – Systemic Corticosteroid - Part C | string | - |
Pharmacotherapy_Management_COPD_Exacerbation_Bronchodilator_PartC | Pharmacotherapy Management of COPD Exacerbation – Bronchodilator - Part C | string | - |
Initiation_Of_Alcohol_Or_Other_Drug_Treatment_Part_C | Initiation of Alcohol or other Drug Treatment - Part C | string | - |
Engagement_Of_Alcohol_Or_Other_Drug_Treatment_Part_C | Engagement of Alcohol or other Drug Treatment - Part C | string | - |
Call_Center_Pharmacy_Hold_Time_Part_D | Call Center – Pharmacy Hold Time - Part D | string | - |
Plan_Submitted_Higher_Prices_For_Display_On_MPF_Part_D | Plan Submitted Higher Prices for Display on MPF - Part D | string | - |
Reminders_To_Fill_Prescriptions_Part_D | Reminders to Fill prescriptions - Part D | string | - |
Reminders_To_Take_Medications_Part_D | Reminders to Take Medications - Part D | string | - |
Grievance_Rate_Part_C_and_D | Grievance Rate - Part C&D | string | - |
Disenrollment_Getting_Needed_Care_Coverage_Cost_Info_PartC_And_D | Disenrollment Reasons - Problems Getting Needed Care, Coverage, and Cost Information (MA-PD, MA-only) - Part C&D | string | - |
Disenrollment_With_Coverage_Of_Doctors_And_Hospitals_PartC_And_D | Disenrollment Reasons - Problems with Coverage of Doctors and Hospitals (MA-PD, MA-only) - Part C&D | string | - |
Disenrollment_With_Prescription_Drug_Benefits_And_Coverage_PartC_And_D | Disenrollment Reasons - Problems with Prescription Drug Benefits and Coverage (MA-PD, PDP) - Part C&D | string | - |
Disenrollment_Reasons_Financial_PartC_And_D | Disenrollment Reasons - Financial Reasons for Disenrollment (MA-PD, MA-only, PDP) - Part C&D | string | - |
Disenrollment_Getting_Information_About_Prescription_Drugs_PartC_And_D | Disenrollment Reasons - Problems Getting Information about Prescription Drugs (MA-PD, PDP) - Part C&D | string | - |
Beneficiary_Access_And_Performance_Problems_Part_C_and_D | Beneficiary Access and Performance Problems - Part C&D | string | - |
Data Preview
Contract Number | Contract Name | Organization Name | Parent Organization | FollowUp Visit Mental Illness Within 30 Days Of Discharge PartC | Antidepressant Medication Management 6Months Part C | Continuous Beta Blocker Treatment Part C | Osteoporosis Testing Part C | Testing To Confirm Chronic Obstructive Pulmonary Disease Part C | Doctors Who Communicate Well Part C | Call Center Beneficiary Hold Time Part C | Pneumonia Vaccine Part C | Access To Primary Care Doctor Visits Part C | Calls Disconnected When Customer Calls Health Plan Part C | Pharmacotherapy Mangt COPD Exacerbation Systemic Corticosteroid PartC | Pharmacotherapy Management COPD Exacerbation Bronchodilator PartC | Initiation Of Alcohol Or Other Drug Treatment Part C | Engagement Of Alcohol Or Other Drug Treatment Part C | Call Center Pharmacy Hold Time Part D | Plan Submitted Higher Prices For Display On MPF Part D | Reminders To Fill Prescriptions Part D | Reminders To Take Medications Part D | Grievance Rate Part C and D | Disenrollment Getting Needed Care Coverage Cost Info PartC And D | Disenrollment With Coverage Of Doctors And Hospitals PartC And D | Disenrollment With Prescription Drug Benefits And Coverage PartC And D | Disenrollment Reasons Financial PartC And D | Disenrollment Getting Information About Prescription Drugs PartC And D | Beneficiary Access And Performance Problems Part C and D |
E0654 | IBT VOLUNTARY EMPLOYEE BENEFITS TRUST | TEAMStar Medicare Part D Prescription Drug Program | IBT Voluntary Employee Benefits Trust | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | 0.42 | 0.23 | 2.55 | 100.00 | |||||||
E3014 | PSERS HOP PROGRAM | Pennsylvania Public School Employees Retirement Sy | Commonwealth of PA Pub Schools Retirement System | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | 0.51 | 0.19 | 0.84 | 100.00 | |||||||
E4744 | MODOT/MSHP MEDICAL AND LIFE INSURANCE PLAN | MISSOURI DEPARTMENT OF TRANSPORTATION | Missouri Highways and Transportation Commission | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | Plan not required to report measure | 0.38 | 0.17 | 0.40 | 100.00 | |||||||
H0022 | BUCKEYE COMMUNITY HEALTH PLAN, INC. | Buckeye Health Plan - MyCare Ohio | Centene Corporation | 0.71 | 0.52 | 0.53 | 0.21 | 0.01 | 0.60 | 0.94 | 0.02 | 0.75 | 0.90 | 0.47 | 0.11 | 0.00 | Plan not required to report measure | 0.59 | 0.50 | 0.21 | 80.00 | |||||||
H0028 | CHA HMO, INC. | Humana | Humana Inc. | 0.47 | 0.54 | 0.83 | 0.74 | 0.33 | 92.00 | 0.01 | 0.80 | 0.96 | 0.02 | 0.75 | 0.79 | 0.44 | 0.05 | 0.01 | 88.00 | 0.59 | 0.35 | 2.40 | 0.20 | 0.22 | 0.19 | 0.15 | 100.00 | |
H0029 | COORDINATED CARE OF WASHINGTON, INC. | Allwell | Centene Corporation | 0.88 | 100.00 | |||||||||||||||||||||||
H0034 | HAMASPIK, INC. | Hamaspik, Inc. | Hamaspik of Rockland County, Inc. | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | 0.01 | Plan too new to be measured | Plan too new to be measured | 0.05 | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | 0.00 | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | |
H0062 | SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC. | Allwell | Centene Corporation | 0.62 | 0.00 | 0.66 | 0.93 | 0.01 | 0.45 | 0.06 | 0.03 | 90.00 | 0.55 | 0.43 | 11.63 | 0.22 | 0.27 | 0.18 | 0.19 | 0.18 | 80.00 | |||||||
H0074 | WELLCARE OF MISSISSIPPI, INC. | WellCare | Centene Corporation | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | Plan too new to be measured | |
H0088 | WELLCARE HEALTH INSURANCE OF NEW YORK, INC. | WellCare | Centene Corporation | 0.01 | 0.83 | 0.04 | 0.02 | 98.00 | Plan too small to be measured | 100.00 |