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Quality Management- HEDIS

Simply Healthcare Plans wants to make sure that the health care services you receive are the best in quality care.  For this reason, Simply Healthcare collects HEDIS performance measures and Agency defined measures.  These measures are reported to the Agency for Healthcare Administration (AHCA) annually.
 
HEDIS measures are developed by the National Committee for Quality Assurance (NCQA), which is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. NCQA develops quality standards and performance measures for health care entities. These are the measures and standards that Simply Healthcare Plans and AHCA use to help identify where we need to improve.
 
You can go to http://www.fdhc.state.fl.us/medicaid/quality_mc/index.shtml to see Simply’s as well as all other Medicaid health plans performance. 
 
These measures include:
 
Adolescent Well Care
The percentage of enrolled members 12-21 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN practitioner during the measurement year.
 
Adult BMI Assessment
The percentage of members 18-74 years of age who had an outpatient visit and who had their body mass index documented during the measurement year or the year prior.
 
Adults' Access to Preventive/Ambulatory Health Services 
Ages 20-44 The percentage of members 20 - 44 years of age who had an ambulatory or preventive care visit.
Ages 45-64 The percentage of members 45-64 years of age who had an ambulatory or preventive care visit.
Ages 65+ The percentage of members 65 years and older who had an ambulatory or preventive care visit.
Adults' Access to Preventive/Ambulatory Health Services Total The percentage of members 20 years and older who had an ambulatory or preventive care visit.
 
Annual Dental Visits – Total
The percentage of members age 2-21 who had at least one dental visit during the measurement year.
 
Antidepressant Medication Management
Effective Acute Phase Treatment The percentage of members 18 years of age and older who were diagnosed with a new episode of major depression and remained on antidepressant medication for at least 84 days.
 
Antidepressant Medication Management
Effective Continuation Phase Treatment The percentage of members 18 years of age and older who were diagnosed with a new episode of major depression and remained on antidepressant medication for at least 180 days.
 
Breast Cancer Screening
The percentage of women 40-69 years of age who had a mammogram to screen for breast cancer.
 
Cervical Cancer Screening
The percentage of women 24-64 with one or more Pap tests during the measurement year or the two years prior to the measurement year.
 
Childhood Immunization Status 
Combination 2 Children who received four DTaP; three IPV; one MMR; two Hib; three hepatitis B; and one VZV vaccination on or before the child's second birthday.
 
Childhood Immunization Status 
Combination 3 Children who received all antigens listed in Combination 2 and four pneumococcal conjugate vaccinations on or before the child's second birthday.
 
Comprehensive Diabetes - Eye Exam
A retinal or dilated eye exam by an eye care professional was done during the measurement year OR a negative retinal exam was done by an eye professional in the year prior to the measurement year.
 
Comprehensive Diabetes - Good Control
The most recent HbA1c level is <8.0%.
 
Comprehensive Diabetes - HbA1C Poor Control (Inverse Measure) The most recent HbA1C level is >9.0% or is missing or was not done during the measurement year.
 
Comprehensive Diabetes - HbA1C Testing
HbA1C test was performed during the measurement year.
 
Comprehensive Diabetes - LDL Screening
An LDL-C test was performed during the measurement year.
 
Comprehensive Diabetes - LDL-C Control
The most recent LDL-C level performed during the measurement year is <100 mL.
 
Comprehensive Diabetes – Nephropathy
A urine microalbumin test was done during the measurement year OR there is evidence of nephropathy during the measurement year.
 
Controlling Blood Pressure – Total  
The number of members with hypertension whose most recent BP is <140/90.
 
Follow-Up after Hospitalization for Mental Illness
7 Day The percentage of discharges for members 6 years and older who were hospitalized for a mental health disorder and who had an outpatient visit, an intensive outpatient encounter, or a partial hospitalization with a mental health practitioner within 7 days.
 
Follow-Up after Hospitalization for Mental Illness 
30 Day The percentage of discharges for members 6 years and older who were hospitalized for a mental health disorder and who had an outpatient visit, an intensive outpatient encounter, or a partial hospitalization with a mental health practitioner within 30 days.
 
Follow-Up Care for Children Prescribed ADHD Medication
Continuation and Maintenance The percentage of members 6-12 years of age with an ambulatory prescription dispensed for ADHD medication, who remained on the prescription for 210 days, had one follow-up visit in the initiation phase and two follow-up visits within 9 months after initiation phase ended.
 
Follow-Up Care for Children Prescribed ADHD Medication
Initiation Phase The percentage of members 6-12 years of age with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner with prescribing authority during 30 days.
 
Frequency of HIV Disease Monitoring Lab Tests
CD4 The percentage of enrollees with HIV who received greater than or equal to 3 CD4 tests during the calendar year.
 
Frequency of HIV Disease Monitoring Lab Tests
VL The percentage of enrollees with HIV who received greater than or equal to 3 viral load tests during the calendar year.
 
Highly Active Anti-Retroviral Treatment
The percentage of enrollees with AIDS who were prescribed HAART.
 
Immunization for Adolescents
Combination 1 The percentage of adolescents 13 years of age who had meningococcal and Tdap/Td.
 
Lead Screening in Children
Children who received one or more capillary or venous lead blood tests for lead poisoning by their second birthday.
 
Lipid Profile Annually
The percentage of members 18 to 85 years of age who had a diagnosis of hypertension and who had a lipid profile during the measurement year that includes total cholesterol, HDL, and triglycerides.
 
Persistence of Beta
Blocker Treatment After a Heart Attack Percentage of members 18 and older who were hospitalized with a diagnosis of AMI and who received beta-blockers for 6 months after discharge.
 
Prenatal Care
The percentage of deliveries that received a prenatal care visit as a member of the plan in the first trimester OR within 42 days of enrollment in the plan.
 
Prenatal Care Frequency 
Greater than 81% of Visits The percentage of Medicaid deliveries that received greater than 81% of expected prenatal visits.
 
Postpartum Care
The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.
 
Readmission Rate (Inverse Measurement)
The percentage of enrollees who were hospitalized for a mental health diagnosis and were discharged to the community from an acute care facility and were readmitted for a mental health diagnosis within 30 days.
 
Use of Angiotensin
Converting Enzyme (ACE) Inhibitors/ Angiotensin Receptor Blockers (ARB) Therapy The percentage of members 18 years and older during the measurement year who were diagnosed with congestive heart failure, and who have at least one prescription filled for ACE inhibitors or ARBs during the measurement year.
 
Use of Appropriate Medications for People with Asthma
Total The percentage of members 5-56 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year.
 
Well - Child 0 Visits (Inverse Measure)
The percentage of children who turned 15 months old during the measurement year who had zero well-child visits with a PCP.
 
Well - Child 6+ Visits
The percentage of children who turned 15 months old during the measurement year who had six or more well-child visits with a PCP.
 
Well - Child Visits in the Third, Fourth, Fifth, & Sixth Years of Life
The percentage of members 3-6 years of age who received one or more well-child visits with a PCP during the measurement year.