HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures designed to ensure that purchasers and consumers can reliably compare the performance of health care organizations. HEDIS is maintained by NCQA (National Committee for Quality Assurance), a not-for-profit organization committed to evaluating and publicly reporting on the quality of physicians, health maintenance organizations, physician organizations and physician hospital organizations. For 2013, in preparation for the State Health Exchanges, health plan organizations are concentrating and focused on HEDIS measures.
HEDIS Measures are of value to all shoppers of healthcare services including providers. Physicians, physician organizations and physician hospital organizations have been requesting a composite set of quality measures that would sharpen the focus of the provider and facilitate process improvement. HEDIS consists of 75 measures across 8 domains of care. Each Healthcare Organization may emphasize different HEDIS measures.
The 2013 BCBSM PGIP (Physician Group Incentive Program) has chosen 22 HEDIS measures that will be used for measuring performance under the Evidence-Based Care Initiative. Stressing these capabilities will provide value for the patient and the physician.
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Preventive Screening
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Childhood Immunization Status (Combo 3)
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Breast Cancer Screening
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Colorectal Cancer Screening
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Chlamydia Screening
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Prenatal and Postpartum Care
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Respiratory Conditions
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Appropriate Testing for Children with Pharyngitis
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Appropriate Treatment for Children with an Upper Respiratory Infection
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Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
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Use of Spirometry Testing in the Assessment and Diagnosis of COPD
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Use of Appropriate Medications for People with Asthma (Total Rate)
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Comprehensive Diabetes Care
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HbA1c Testing
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Retinal Eye Exam
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LDL-C Screening Test
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Monitor for Nephropathy
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HbA1c Poor Control >9%
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Musculoskeletal Conditions
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Use of Imaging Studies for Low Back Pain (Inverted Rate)
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Behavioral Health
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Antidepressant: Effective Acute Phase Treatment
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Antidepressant: Effective Continuation Phase Treatment
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ADHD: Initiation Phase (6-12 years)
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ADHD: Continuation and Maintenance (C&M) Phase (6-12 years)
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Cardiovascular Conditions
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Cholesterol Management for Patients With Cardiovascular Conditions
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Persistence of Beta-Blocker Treatment After a Heart Attack
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