Superior HealthPlanHEDIS Resources
Talking Points!
A Closer Look at Health Plan Performance
HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) which allows comparison across health plans. Health plans are held accountable for performance on measures related to preventive care, early diagnosis and appropriate care of specific medical conditions, as well as Access to Care and Use of Services measures. HEDIS is a required component of health plan accreditation and is submitted to NCQA.
Superior’s 2012 HEDIS ratings:
Superior HealthPlan (Superior) uses HEDIS data to identify areas for improvement and monitor ongoing initiatives. Most data are sourced from claims, ImmTrac and medical record reviews. All data is audited by an NCQA certified auditor prior to submission. Below are selected measures that demonstrate “Good Performance” and areas that are “In Need of Improvement”, based on Superior’s 2011 HEDIS ratings.
GOOD PERFORMANCE
| Measure | 2011 Superior HealthPlan Score | 2012 Superior HealthPlan Score | NCQA HEDIS 2012 National HMO Medicaid 75th Percentile |
| Childhood Immunization Status (Combo 2 – DTaP, OPV, MMR, HiB, Hep B, VZV) | 82.6% | 83.2% | 80.8% |
| Immunization for Adolescents (Combo 1 – Meningococcal and Tdap/Td) | 75.6% | 82.7% | 80.8% |
| Well Child visits in the First 15 Months of Life – 6 Visits | 56.9% | 63.0% | 70.7% |
| Well Child Visits in the 3rd, 4th, 5th & 6th Years of Life | 78.7% | 80.5% | 79.3% |
| Use of Approrpriate Medications for People with Asthma | 94.5% | 93.0% | 88.2% |
IN NEED OF IMPROVEMENT
| Measure | 2011 Superior HealthPlan Score | 2012 Superior HealthPlan Score | NCQA HEDIS 2012 National HMO Medicaid 75th Percentile |
| Adolescent Well Care | 60.6% | 57.3% | 57.6% |
| Timeliness of Prenatal Care | 93.6% | 92.0% | 90.4% |
| Postpartum Care | 68.9% | 67.0% | 71.1% |
| Cholesterol Management for Members with Cardiovascular Disease | 87.4% | 84.9% | 85.1% |
| Comprehensive Diabetes Care – Annual HbA1c Testing | 80.3% | 82.2% | 87.0% |
| Children with Pharyngitis | 53.5% | 57.1% | 76.4% |
What are the next steps?
Superior utilizes HEDIS to pinpoint areas in our healthcare delivery process where we succeed, as well as where we need improvement. Superior’s Quality Improvement (QI) Department analyzes HEDIS results and assists the plan in identifying opportunities for performance improvement. Superior’s QI Committee Structure focuses upon quality patient care, improved outcomes, and collaborative interventions with network Providers that enhance the overall patient experience. For additional information about our Quality Assessment and Performance Improvement Program, click here.
Who should I contact at Superior for Assistance?
If you have any questions, comments, or concerns related to the annual HEDIS project, please contact Superior’s QI Department at SHPHEDIS@centene.com.