Thank you for participating in the annual Healthcare Effectiveness Data and Information Set (HEDIS) commercial data collection project for 2018. You play a central role in promoting the health of our members. By documenting services in a consistent manner, it is easy for you to track care that was provided and identify any additional care that is needed to meet the recommended guidelines.  Consistent documentation and responding to our medical record requests in a timely manner eliminates follow up calls to your office and also helps improve HEDIS scores, both by improving care itself and by improving our ability to report validated data regarding the care you provided. The records that you provide to us directly affect the HEDIS results that are listed below.

 

Each year our goal is to improve our process for requesting and obtaining medical records for our HEDIS project. In order to demonstrate the exceptional care that you have provided to our members and in an effort to improve our scores, you and your office staff can help facilitate the HEDIS process improvement by:

  • Responding to our requests for medical records within five days, if possible
  • Providing the appropriate care within the designated timeframes
  • Accurately coding all claims
  • Documenting all care clearly in the patient’s medical record

 

Further information regarding documentation guidelines and administrative codes can be found on the HEDIS page of our Provider Portal. In addition more information on HEDIS can be found on the Quality Improvements and Standards page of our bcbsga.com/provider website. You will find reference documents entitled “HEDIS 101 for Providers” and “HEDIS Physician Documentation Guidelines and Administrative Codes”.

 

The attached PDF includes a table that shows some of our key measure rates across Georgia.

  • Yellow boxes indicate rates that are above the national average.
  • Bold indicates improvement in rate over the previous year.
  • Comprehensive Diabetes Care - Poor HbA1c Control (>9): Lower rate is good

See attached PDF titled GA HEDIS 2018 results.

In Georgia, Commercial HMO rates improved and/or exceeded the national average. 

  • Measures with rate increases include:
    Adult BMI Assessment
  • Weight Assess/Counseling – BMI Total
  • Weight Assess/Counseling – Physical Activity Total
  • Chlamydia Screening in Women – Total
  • Appropriate Testing Children w/ Pharyngitis
  • Appropriate Treatment for Children With Upper Respiratory Infection
  • Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
  • Spirometry Testing for COPD
    Pharmacotherapy Mgmt COPD – Bronchodilator
  • Persistence of Beta-Blocker Treatment after AMI
  • Comprehensive Diabetes Care – HbA1c Testing
  • Comprehensive Diabetes Care – HbA1c <8
  • Comprehensive Diabetes Care – Blood Pressure <140/90
  • Use of Imaging Studies for Low Back Pain
  • Well-Child Visits in the first 15 Months of Life (6+ visits)
  • Well-Child Visits 3 to 6 Years of Life
  •  Adolescent Well-Care Visits


Measures where there are opportunities for improvement include:

  • Weight Assess/Counseling – Nutrition Counseling Total
  • Childhood Immunization Status – Combo 10
  • Immunizations for Adolescents – TDAP
  • Immunizations for Adolescents – Combo 1
  • Cervical Cancer Screening
  • Colorectal Cancer Screening
  • Controlling High Blood Pressure
  • Comprehensive Diabetes Care – Eye Exams
  • Comprehensive Diabetes Care – Nephropathy
  • Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
  • Prenatal/Postpartum Care – Timeliness of Prenatal Care
  • Prenatal/Postpartum Care – Postpartum Care

 

In Georgia, Commercial PPO rates improved and/or exceeded the national average.  Measures with rate increases include:

  • Adult BMI Assessment
  • Weight Assess/Counseling – BMI Total
  • Weight Assess/Counseling – Nutrition Counseling Total
  • Weight Assess/Counseling – Physical Activity Total
  • Cervical Cancer Screening
  • Chlamydia Screening in Women – Total
  • Appropriate Testing Children w/ Pharyngitis
  • Spirometry Testing for COPD
  • Pharmacotherapy Mgmt COPD – Bronchodilator
  • Comprehensive Diabetes Care – HbA1c Testing
  • Comprehensive Diabetes Care – HbA1c <8
  • Comprehensive Diabetes Care – Eye Exams
  • Comprehensive Diabetes Care – Blood Pressure <140/90
  • Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
  • Appropriate Treatment Children w/ URI
  • Antibiotic Treatment Adults w/ Acute Bronchitis
  • Use of Imaging Studies for Low Back Pain
  • Prenatal/Postpartum Care – Timeliness of Prenatal Care
  • Prenatal/Postpartum Care – Postpartum Care
  • Well-Child Visits in the first 15 Months of Life (6+ visits)
  • Well-Child Visits 3 to 6 Years of Life
  • Adolescent Well-Care Visits

 

Measures where there are opportunities for improvement include:

  • Childhood Immunization Status – Combo 10
  • Immunizations for Adolescents – MENIN
  • Immunizations for Adolescents – TDAP
  • Immunizations for Adolescents – Combo 1
  • Colorectal Cancer Screening
  • Persistence of Beta-Blocker Treatment after AMI
  • Comprehensive Diabetes Care – Nephropathy

 

Now is the time to review your patient’s records to ensure that they have received their preventative care and/or immunizations before the end of the year.

 

Again, we thank you and your staff for demonstrating teamwork as we work together to improve the health of our members and your patients. We look forward to working with you again next HEDIS season.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)



Featured In:
December 2018 BCBSGa Provider Newsletter