HEDIS Part C Disease Screening Quality Measures 2010 to 2016

$199 / year

The dataset explains different metrics or standard of measurement for Part C (Medicare private health plans) reported at the contract level with less than 500 enrolled. Medicare Part C 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

2014-01-01 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 Processmance Quality Measures Medicare Ratings 2016

Other Titles

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

Name Description Type Constraints
YearPerformance Year of Part C (2014, 2015 and 2016)date-
Contract_NumberContract number for measurement for Part Cstring-
Organization_Marketing_NameOrganization Marketing Namestring-
Contract_NameContract Name (Insurance Company)string-
Parent_OrganizationParent Organization of Insurance Companystring-
Breast_Cancer_ScreeningPerformance data for Breast Cancer Screeningstring-
Colorectal_Cancer_ScreeningPerformance data for Colorectal Cancer Screeningstring-
Cardiovascular_Care_Cholesterol_ScreeningPerformance data for Cardiovascular Care (Cholesterol Screening)string-
Diabetes_Care_Cholesterol_ScreeningPerformance data for Diabetes Care (Cholesterol Screening)string-
Glaucoma_TestingPerformance data for Glaucoma Testingstring-
Adult_BMI_AssessmentPerformance data for Adult BMI Assessmentstring-
Care_For_Older_Adults_Medication_ReviewCare for Older Adults Medication Reviewstring-
Care_For_Older_Adults_Functional_Status_AssessmentCare for Older Adults (Functional Status Assessment)string-
Care_For_Older_Adults_Pain_AssessmentCare for Older Adults (Pain Assessment)string-
Osteoporosis_Management_In_Women_Who_Had_A_FracturePerformance data for Osteoporosis Management in Women who had a Fracturestring-
Diabetes_Care_Eye_ExamPerformance data for Diabetes Care (Eye Exam)string-
Diabetes_Care_Kidney_Disease_MonitoringPerformance data for Diabetes Care (Kidney Disease Monitoring)string-
Diabetes_Care_Blood_Sugar_ControlledPerformance data for Diabetes Care (Blood Sugar Controlled)string-
Diabetes_Care_Cholesterol_ControlledPerformance data for Diabetes Care (Cholesterol Controlled)string-
Controlling_Blood_PressurePerformance data for Controlling Blood Pressurestring-
Rheumatoid_Arthritis_ManagementPerformance data for Rheumatoid Arthritis Managementstring-
Plan_All_Cause_ReadmissionsPlan for all cause readmissionsstring-
YearContract_NumberOrganization_Marketing_NameContract_NameParent_OrganizationBreast_Cancer_ScreeningColorectal_Cancer_ScreeningCardiovascular_Care_Cholesterol_ScreeningDiabetes_Care_Cholesterol_ScreeningGlaucoma_TestingAdult_BMI_AssessmentCare_For_Older_Adults_Medication_ReviewCare_For_Older_Adults_Functional_Status_AssessmentCare_For_Older_Adults_Pain_AssessmentOsteoporosis_Management_In_Women_Who_Had_A_FractureDiabetes_Care_Eye_ExamDiabetes_Care_Kidney_Disease_MonitoringDiabetes_Care_Blood_Sugar_ControlledDiabetes_Care_Cholesterol_ControlledControlling_Blood_PressureRheumatoid_Arthritis_ManagementPlan_All_Cause_Readmissions
2014H4910Aetna MedicareAETNA HEALTH, INC. (PA)Aetna Inc.616587946858Not enough data available6891715159Not enough data available10
2014H6923Aetna MedicareAETNA HEALTH, INC. (PA)Aetna Inc.675490845661Not enough data available5792765461Not enough data available12
2014H2457MHPMETROPOLITAN HEALTH PLANMetropolitan Health Plan595169787895Not enough data available7990835672Not enough data available15
2014H3132AHFAHF MCO OF FLORIDA, INC.AIDS Healthcare Foundation766495926190Not enough data available4480663966Not enough data available12
2014H5852AHFAIDS HEALTHCARE FOUNDATIONAIDS Healthcare Foundation676988937283Not enough data available5687765368Not enough data available15
2014H1846MediGoldMOUNT CARMEL HEALTH INSURANCE COMPANYTrinity Health724093906064Not enough data available5992344439Not enough data available11
2015H3132AHFAHF MCO OF FLORIDA, INC.AIDS Healthcare Foundation57939491.248958.1688.65Not enough data available4979635563Not enough data available16
2014H5685Midwest AdvantageMIDWEST HEALTH PLAN, INC.Henry Ford Health System664977766983Not enough data available6490514276Not enough data available15
2014H5943VillageHealthSCAN HEALTH PLANSCAN Health Plan434879717728Not enough data available5910021Not enough data availableNot enough data available9
2015H5852AHFAIDS HEALTHCARE FOUNDATIONAIDS Healthcare Foundation62939093.199789.1396.74Not enough data available5887735268Not enough data available29.15
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