Appendix 1
HEDIS
2007
Summary
Table of Measures,
Product Lines and Changes
SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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General Guidelines for Data Collection and Reporting |
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General Guidelines for Calculations and Sampling |
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Effectiveness of Care |
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Specific Guidelines for Effectiveness of Care Measures |
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Childhood Immunization Status |
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Adolescent Immunization Status |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Effectiveness of Care |
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Appropriate Treatment for Children With Upper Respiratory Infection |
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Appropriate Testing for Children With Pharyngitis |
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Inappropriate Antibiotic Treatment for Adults With Acute Bronchitis |
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Colorectal Cancer Screening |
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Breast Cancer Screening |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Effectiveness of Care |
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Cervical Cancer Screening |
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Chlamydia Screening in Women |
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Osteoporosis Management in Women Who Had a Fracture |
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Controlling High Blood Pressure |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Effectiveness of Care |
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Controlling High Blood Pressure |
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Beta-Blocker Treatment After a Heart Attack |
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Persistence of Beta-Blocker Treatment After a Heart Attack |
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Cholesterol Management for Patients With Cardiovascular Conditions |
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Comprehensive Diabetes Care |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Effectiveness of Care |
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Comprehensive Diabetes Care |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Effectiveness of Care |
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Use of Appropriate Medications for People With Asthma |
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Use of Spirometry Testing in the Assessment and Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) |
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Follow-Up After Hospitalization for Mental Illness |
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Antidepressant Medication Management |
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Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication |
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Glaucoma Screening in Older Adults |
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Use of Imaging Studies for Low Back Pain |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Effectiveness of Care |
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Use of Imaging Studies for Low Back Pain |
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Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis |
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Annual Monitoring for Patients on Persistent Medications |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Effectiveness of Care |
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Drugs to Be Avoided in the Elderly |
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Potentially Harmful Drug-Disease Interactions in the Elderly |
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Medical Assistance With Smoking Cessation |
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Flu Shots for Adults Ages 50–64 |
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Flu Shots for Older Adults |
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Pneumonia Vaccination Status for Older Adults |
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The Medicare Health Outcomes Survey |
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Management of Urinary Incontinence in Older Adults |
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Physical Activity in Older Adults |
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Fall Risk Management |
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Osteoporosis Testing in Older Women |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Access/Availability of Care |
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Adults’ Access to Preventive/ Ambulatory Health Services |
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Children’s and Adolescents’ Access to Primary Care Practitioners |
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Prenatal and Postpartum Care |
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Annual Dental Visit |
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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment |
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Claims Timeliness |
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Call Answer Timeliness |
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Call Abandonment |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Satisfaction With the Experience of Care |
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CAHPS Health Plan Survey 4.0H, Adult Version |
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CAHPS Health Plan Survey 3.0H, Child Version |
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Children With Chronic Conditions |
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Health Plan Stability |
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Practitioner Turnover |
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Years in Business/Total Membership |
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Use of Services |
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Specific Guidelines for Use of Services Measures |
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Frequency of Ongoing Prenatal Care |
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Well-Child Visits in the First 15 Months of Life |
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Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life |
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Adolescent Well-Care Visits |
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Frequency of Selected Procedures |
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Inpatient Utilization—General Hospital/ Acute Care |
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Ambulatory Care |
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Inpatient Utilization—Nonacute Care |
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Discharges and Average Length of Stay—Maternity Care |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Use of Services |
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Births and Average Length of Stay, Newborns |
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Mental Health Utilization—Inpatient Discharges and Average Length of Stay |
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Mental Health Utilization—Percentage of Members Receiving Inpatient and Intermediate Care and Ambulatory Services |
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Chemical Dependency Utilization—Inpatient Discharges and Average Length of Stay |
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Identification of Alcohol and Other Drug Services |
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Outpatient Drug Utilization |
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Antibiotic Utilization |
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Cost of Care |
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Specific Guidelines for Cost of Care Measures |
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Relative Resource Use for People With Diabetes |
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Relative Resource Use for People With Asthma |
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HEDIS 2007 Measures |
Applicable to: |
Changes to HEDIS 2007 |
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Commercial |
Medicaid |
Medicare |
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Cost of Care |
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Relative Resource Use for People With Acute Low Back Pain |
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Relative Resource Use for People With Cardiac Conditions |
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Relative Resource Use for People With Uncomplicated Hypertension |
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Relative Resource Use for People With COPD |
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Informed Health Care Choices |
There are currently no measures in this domain. |
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Health Plan Descriptive Information |
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Board Certification |
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Enrollment by Product Line |
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Enrollment by State |
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Race/Ethnicity Diversity of Membership |
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Language Diversity of Membership |
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Weeks of Pregnancy at Time of Enrollment in the MCO |
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Appendix 2
Technical Considerations
for First-Year Measures
The NCQA Committee on Performance Measurement (CPM) approved four new measures for HEDIS 2007. These measures provide feasible assessment strategies that are meaningful to consumers, purchasers, health plans and clinicians.
As shown below, not all measures are proposed for all three product lines.
New HEDIS 2007 Measure |
Product Line |
Data Source |
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Commercial |
Medicaid |
Medicare |
Admin |
Hybrid |
Survey |
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Effectiveness of Care |
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Potentially Harmful Drug-Disease Interactions in the Elderly |
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Cost of Care |
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Relative Resource Use for People With Diabetes |
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Relative Resource Use for People With Asthma |
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Relative Resource Use for People With Acute Low Back Pain |
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Description
The percentage of Medicare members 65 years of age and older who have evidence of an underlying disease, condition or health concern and who were dispensed an ambulatory prescription for a contraindicated medication, concurrent with or after the diagnosis.
Selected disease/condition and potentially harmful therapeutic agent combinations include:
History of falls
Tricyclic antidepressants
Antipsychotics
Sleep agents
Dementia
Tricyclic antidepressants
Anticholinergic agents
Chronic renal failure
Nonaspirin NSAIDs
Cox-2 Selective NSAIDs
Background
Despite publication of several manuscripts that identified drugs considered inappropriate for use in the elderly—particularly in the presence of specific diagnoses—clinical evidence suggests that these agents are being prescribed for persons 65 years of age and older. Their use is identified with adverse drug events that contribute to hospitalization, increased length of hospital stay and duration of illness, nursing home placement and other events, such as falls and fractures, which are associated with physical, functional and social declines in the elderly.
Pharmacotherapy is an essential component of medical treatment for older patients, but medications are also responsible for many adverse events in this group. Almost 90 percent of people 65 years of age or older take at least 1 medication, significantly more than any other age group (AHRQ, 2001). In 1999, Medicare beneficiaries composed only 14 percent of the community population but accounted for more than 41 percent of prescription medication expenses. The average drug expense was about four times higher for Medicare beneficiaries ($990) than for the non-Medicare population ($236) (Stagnitti, 2003). Many older persons take multiple drugs for the treatment of several conditions, which increases the chance of adverse drug reactions (ADR), drug-drug interactions and drug-disease interactions.
Adverse drug reactions occur commonly in older ambulatory adults with a reported prevalence ranging between 5 percent and 35 percent (Hanlon, 2001; Gurwitz, 2003; Hanlon, 1997; Chrischilles, 1992). They are a major threat to the health-related quality of life of community-dwelling older seniors and account for the expenditure of billions of health care dollars each year in the United States (Hanlon, 2001; Kohn, 2000; Ernst, 2001).
Inappropriate medication use and adverse drug-related outcomes in older adults are becoming increasingly serious problems for many managed care organizations (MCO) (Mackinnon, 2003). Zhan and colleagues observed that 21.3 percent of seniors in the ambulatory setting in the United States are prescribed a potentially inappropriate medication (Zhan, 2001).
Health importance |
Patient safety is highly important to the health of members, especially patients who are at increased risk of adverse drug events due to coexisting conditions and polypharmacy. Thirty percent of hospital admissions in elderly patients may be linked to drug-related problems or toxic effects (Hanlon, 1997). Adverse drug events (ADE) have been linked to preventable problems in elderly patients, such as depression, constipation, falls, immobility, confusion and hip fractures (Hanlon, 1997; Bootman 1997). Use of medications that pose high risk to the elderly is likely to increase the cost of care while decreasing its quality. It has been estimated that more than 10 percent of all hospitalizations for the elderly are related to adverse drug expenditures (Williams, 1992; Monane, 1997; Tamblyn, 1996). Potentially inappropriate prescribing of medications (PIRx) occurs in hospitals, emergency departments (ED) and ambulatory settings. Patients 65 and older are at significant risk of PIRx owing to polypharmacy for multiple conditions, and for resulting adverse drug events that range from minor symptoms to serious adverse effects, including sedation and life-threatening arrhythmia (Lau, 2005). |
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Financial importance |
In 1999, the difference in mean drug expenses between the Medicare and non-Medicare populations came primarily from differences in the quantities of drugs purchased rather than differences in the price paid for drugs. The average number of prescription drug purchases was higher for Medicare beneficiaries than for the non-Medicare population (Stagnitti, 2003). The cost of medication use by the 24 million Americans (Monane, 1997) over 65 is higher than $25.5 billion per year (Bootman, 1997; Lubitz, 1995). Drug expenses account for 23 percent of the total cost of caring for older persons, largely due to the burden of chronic disease (Beers, 2000). Recent estimates of the overall human and economic consequences of medication-related problems vastly exceed the findings of the Institute of Medicine on deaths from medical errors, estimated to cost the nation $8 billion annually. It is estimated that medication-related problems cause 106,000 deaths annually, at a cost of $85 billion (Perry, 1999). Others have calculated the cost of medication-related problems to be $76.6 billion to ambulatory care, $20 billion to hospitals, and $4 billion to nursing home facilities (Bootman, 1997; Bates, 1997; Johnson, 1995). |
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Cost effectiveness |
As
MCOs consider the best allocation of resources to improve
medication use, Reducing high-risk drug prescriptions in the elderly represents an opportunity to reduce the cost associated with harm from medication (e.g., hospitalization caused by drug toxicity), as well as reduce the cost of the medications by encouraging clinicians to consider safer alternatives. Patients receiving a potentially inappropriate medication have significantly higher provider and facility costs and a higher mean number of inpatient, outpatient and ED visits than comparisons after controlling for sex, the Charlson Comorbity Index and the total number of prescriptions (Fick, Walter, et al.). |
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Potential for improvement |
As noted above, different indicator and aggregate measure rates vary by condition and by plan to a different extent. Field test results indicate the potential for improvement appears to be small across the aggregate measure and indicators; however, considering that drug-disease interactions in the elderly are a safety concern, there is room for improvement in the falls, dementia and renal failure. |
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Scientific Soundness
Clinical importance and evidence |
Moderate to high. There is clinical consensus that certain drugs increase the risk of harm in the elderly (Fick, 2003; Beers, 1997; Zahn, 2001) and should generally be avoided. Appropriate use of prescription drugs in the elderly, including proper drug selection, has been identified as an important quality of care issue (Knight, 2001; Classen, 2003), and explicit criteria defining inappropriate drug use is an important tool when evaluating prescribing to populations (Fick, 2003; Beers, 1997; Zahn 2001; Anderson, 1997). A recently published study of inappropriate medication use with the Beers criteria in a Medicare-managed care population found a potentially inappropriate medication (PIM) prevalence of 23 percent (541/2,336) (Fick, Waller). Drug-disease interactions identified for reporting in this measure are based on the literature and on the key clinical expert consensus process by Beers (2003) that identified potentially inappropriate medication use in older adults with specific diagnoses or conditions. NCQA’s medication management expert panel provided advice on the conditions and drugs to be included in this measure, based on the updated Beers list and a Canadian panel (McLeod, 1997) and significance of harm and impact on the older adult population. The following table illustrates the disease/condition, drug, concern and severity rating as reported in the literature. |
Disease/Condition |
Drug |
Concern |
Severity Rating |
History of falls* |
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Dementia*† |
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Chronic renal failure† |
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*2002 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: Considering Diagnosis or Conditions (Fick, 2003)
†1997 Canadian Criteria Defining Inappropriate Practices in Prescribing for Elderly People (McLeod, 1997)
Validity |
High to moderate. This measure identifies the potential for inappropriate prescribing in the elderly population with specific conditions. It provides valid and reliable data on members’ experiences with drugs prescribed throughout the year. Field test medical record validation of the denominators ranged from 85 to 96 percent across conditions; in addition, the concordance between administrative and medical record data for the numerators ranged from 86.6 to 98 percent. |
Feasibility
Logistically feasible |
High. This measure has sufficient denominator size for reporting and plans have the necessary data to identify the measure denominator and numerator events. |
Auditable |
High to moderate. While this measure has not yet been implemented, its auditability was reviewed by NCQA’s internal HEDIS Audit and Software Certification staff and is constructed in a manner similar to measures known to be auditable. |
References
Anderson, G.M., M.H. Beers, K. Kerluke. Auditing prescription practice using explicit criteria and computerized drug benefit claims data. J Eval Clin Prac. 1997; 3 (4): 283-294.
Bates, D.W., N. Spell, D.J. Cullen, et al. The Adverse Drug Events Prevention Study Group. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277:307-311.
Beers M.H., R.W. Baran, K. Frenia. Drugs and the elderly, Part I: The problems facing managed care. Am J Managed Care. 2000;6:1313-20.
Idem. Drugs and the elderly, Part 2: Strategies for improving prescribing in a managed care environment. Am J Managed Care. 2001;7:69-72.
Bootman, J.L., D.L. Harrison, E. Cox. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med. 1997;157:2089-96.
Chrischilles, E.A., E.T. Segar, R.B. Wallace. Self-reported adverse drug reactions and related resource use. A study of community-dwelling person 65 years of age and older. Ann Intern Med. 1992;117:634-640.
Classen, D. Editorial: Medication safety. Moving from illusion to reality. JAMA. 2003; 289(9): 1154-1156.
Ernst, F.R., and A.J. Grizzle. Drug-related morbidity and mortality: Updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41:192-199.
Fick, D.M., J.W. Cooper, W.E. Wade, J.L. Waller, J.R. Maclean, M.H. Beers. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med. 2003; 163: 2716-2724.
Grossberg, G.T., and J.A. Grossberg. Epidemiology of psychotherapeutic drug use in older adults. Clin Geriatr Med. 1998;14:1-5.
Gurwitz, J.H., T.S. Field, L.R. Harrold, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107-1116.
Hanlon, J.T., S.L. Gray, K.E. Schmader. Adverse drug reactions. In: Delafuente, J.C., R.B. Stewart, eds. Therapeutics in the Elderly. 3rd ed. Cincinnati, Ohio: Harvey Whitney Books; 2001: 289-314.
Hanlon, J.T., K.E. Schmader, M.J. Koronkowski, et al. Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997;45:945-948.
Harrison, D.L., J.L. Bootman, E.R. Cox. Cost-effectiveness of consultant pharmacists in managing drug-related morbidity and mortality in nursing facilities. Am J Health-Syst Pharm. 1998;55(15):1588-94.
Highlights #9: Health Care Use in America, 1996. April 2001. Agency for Healthcare Research and Quality, Rockville, MD. http:www.meps.ahrq.gov/papers/hl9_99-0029/hl9.htm
Institute of Medicine, (US) Committee on Quality Health Care in America, Crossing the Quality Chasm: A New Health System for the 21st Century, Washington D.C., National Academy Press, 2001
Johnson, J.A., and J.L. Bootman. Drug-related morbidity and mortality: a cost-of-illness model. Arch Intern Med. 1995;155:1949-1956.
Knight, E.L., and J. Avorn. Quality indicators for appropriate medication use in vulnerable elders. Anns Int Med 2001; 135 (8: Part 2): 703-710.
Kohn, L.T., J.M. Corrigan, M.S. Donaldson, eds. for the Committee on Quality of Health Care in America, Institute of Medicine. In: To Err is Human, Building a Safer Health System. Washington, DC: National Academy Press; 2000.
Lau, D.T., J.D. Kasper, E.B. Potter, et al. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med. 2005;165:68-74.
Lubitz, J., J. Beebe and C. Baker. Longevity of Medicare expenditures. N Engl J Med. 1995;332:999-1003.
MacKinnon, N.J., and C.D. Hepler. Preventable Drug-related Morbidity in Older Adults Part 1: Indicator Development. J Mg Care Pharm. 2002; 8 (5): 365-371.
Mackinnon, N.J., C.D. Hepler. Indicators of Preventable Drug-related Morbidity in Older Adults: Use Within a Managed Care Organization. J Managed Care Pharm. 2003; 9:134-41.
McLeod, P.J., A.R. Huang, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. Can Med Assoc J. 1997;156(3):385-391.
Monane, M., S. Monane, T. Semla. Optimal medication use in elders. Key to successful aging. West J Med. 1997;167(4):233-237.
Okano, G.J., D.C. Malone, S.J. Billups, et al. Reduced quality of life in veterans at risk for drug-related problems. Pharmacotherapy. 2001;21:1123-29.
Perry, D.P. When medicine hurts instead of helps. Consultant Pharmacist. 1999;14:1326-1330.
Ray, W.A., M.R. Griffin, W. Schaffner, et al. Psychotropic drug use and the risk of hip fracture. N Engl J Med. 1987;316:363-369.
Shorr, R.I., S.F. Bauwens, C.S. Landefeld. Failure to limit quantities of benzodiazepine hypnotic drugs for outpatients: Placing the elderly at risk. Am J Med. 1990;89:725-732.
Stagnitti, M.N., G.E. Miller, J.F. Moeller. Outpatient prescription drug expenses, 1999. Rockville (MD): Agency for Healthcare Research and Quality; 2003. MEPS Chartbook No. 12. AHRQ Pub. No. 04-0001.
Tamblyn, R. Medication use in seniors: Challenges and solutions. Therapie. 1996;51:269-282.
Tinetti, M.E., M. Speechley, S.F. Ginter. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701-1707.
Tune, L.E. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001;62(Suppl 21):11-14.
Williams, L., and D.T. Lowenthal. Drug therapy in the elderly. South Med J. 1992;85(2):127-131.
Zhan, C., J. Sangl, A.S. Bierman, et al. Potentially in appropriate medication use in the community-dwelling elderly. JAMA. 2001;286:2823-29.
Relative Resource Use (RRU)
Description
These measures provide a standardized approach to the measurement of resource use. When coupled with the current quality of care HEDIS measures, they provide more information about the efficiency or value of services rendered by a health plan.
The following measures will be reported and collected as first-year measures for HEDIS 2007.
Relative Resource Use for People With Diabetes
Relative Resource Use for People With Asthma
Relative Resource Use for People With Acute Low Back Pain
The following measures are included in Volume 2 but will be collected as first-year measures beginning in HEDIS 2008.
Relative Resource Use for People With Cardiac Conditions
Relative Resource Use for People With Chronic Obstructive Pulmonary Disease (COPD)
Relative Resource Use for People With Uncomplicated Hypertension
Relevance
Meaningfulness |
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…to consumers |
Moderate. NCQA is interested in providing these measures in a way that is meaningful and useful to consumers when making cost and quality decisions. |
…to purchasers |
High. Purchasers on NCQA’s Purchaser Advisory Council indicate that measures of relative resource use for highly prevalent and costly conditions should provide needed additional information. Because these measures hold prices constant, they allow purchasers to better understand the underlying productivity of the health plan. In addition, because the RRU measure eligible populations represent eligible populations in current HEDIS quality measures, purchasers can link the data from the two types of measures (quality and resource) for a better idea of the value of the health plan. |
…to plans/ providers |
High. Health plans and providers are likely to find the measure outcomes useful for evaluating their costs for managing chronic illnesses and improving the health status of their membership. |
Financial importance |
High. Health care costs have continued to escalate at rates that outpace inflation; in 2003, health care expenditures in the United States were nearly $1.7 trillion, representing 15.3 percent of the Gross Domestic Product (GDP) (Henry J. Kaiser Foundation). In 2004, health care premiums experienced their fourth consecutive year of double-digit growth (11 percent), and they continue to increase much faster than overall inflation (2.3 percent) and wage gains (2.2 percent). Since 2000, health care premiums for family coverage have increased by 59 percent, compared with inflation growth of 9.7 percent and wage growth of 12.3 percent (Henry J. Kaiser Foundation). Containing health care costs is one of the most challenging policy issues facing the United States. Health plans and purchasers are interested in standard measures of relative resource utilization because of their potential as tools to reduce costs. Health system efficiencies are often defined as attainment compared to the maximum that could be achieved for the observed level of resource use (Tandon, et. Al.). Research by Wennberg, Fisher, Thorpe and others shows that the problem of variation in intensity of treatment for chronic illness is primarily a problem of overuse and waste, not underuse and health care rationing (i.e., poor quality). NCQA has developed measures of relative resource use for health plans. By holding price constant and linking these measures to quality outcomes measures purchasers, consumers and health plans will be able to better compare their utilization and quality outcomes of their networks with other plan or types of networks. |
Strategic importance |
High. Because of a purchaser’s goal to manage health care dollars and health plan’s goals to strategic priorities, development of these metrics is essential to better relate input costs to output for health care services. |
Controllability |
Health plans can influence resources and types of resources their networks use, while maintaining quality. Examples of influencing resources used include disease management, utilization review, benefit designs, tiered networks and education programs or health promotions. |
Scientific Soundness
Reliability |
Data has demonstrated that these measures produce results similar to a proprietary, well-respected method at the health plan level. The clinical logic to identify the relevant population is similar to current HEDIS measures. NCQA will supply tables or codes for health plans to use, when applicable. Health plans will submit resource use data to NCQA stratified by age and gender and for particular categories of utilization (e.g., inpatient facility), which NCQA will use to calculate the relative resource use index. |
Ability to detect differences among plans |
Data shows relative resource consumption varies appreciably between health plans. Specific findings related to these measures provide insights related to the services, conditions and methods used for study.
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Risk adjustment |
These measures are risk adjusted, using a nonproprietary age-sex and morbidity approach. |
Feasibility
Precisely specified |
These measures have detailed and precise specifications that clearly define the numerator, denominator, data sources, allowable values, methods of measurement and method of reporting. |
Logistically feasible |
With precise specifications, these measures will be feasible to implement, though they may require additional time and monetary commitments from health plans in their initial implementation. |
Auditable |
These measures are considered to be auditable and have been reviewed by NCQA’s Audit Methodology Panel. |
References
Centers for Medicare & Medicaid Services. An Overview of the U.S. Healthcare System: Two Decades of Change, 1980-2000. Office of the Actuary. March 12 2002.
E.S. Fisher, et al., Associations among Hospital Capacity, Utilization, and Mortality of U.S. Medicare Beneficiaries, Controlling for Sociodemographic Factors. Health Services Research, 34 no. 6 (2000): 1351-1362.
Henry J. Kaiser Foundation and Health Research and Educational Trust. Trends and Indicators in the Changing Health Care Marketplace. http://www.kff.org/insurance/7031/ti2004-1-1.cfm (accessed April 2005).
Henry J. Kaiser Foundation and Health Research and Educational Trust. Summary of Findings, Employer Health Benefits 2004 Annual Survey. http://www.kff.org/insurance/7148/summary/index.cfm (accessed May 2005).
Tandon, A., J.A. Lauer, D.B. Evans, C.J.L. Murray. Health System Efficiency: Concepts. Health System Performance Assessment, chapter 50. http://whqlibdoc.who.int/publications/2003/9241562455_(part4)_ (chp50-60).pdf
Thorpe et. al., Health Affairs. August 25, 2004.
Wennberg, J.E., E.S. Fisher, J.S. Skinner. Geography and The Debate Over Medicare Reform. Health Affairs Web Exclusive, February 2002.
Appendix 3
Practitioner Types
Primary care practitioner |
Includes physicians and nonphysicians whom members can select as primary care practitioners and who are defined by the MCO as primary care practitioners. |
Primary care physician |
Includes general or family practice physicians, geriatricians, general internal medicine physicians, general pediatricians and obstetricians/gynecologists (OB/GYN). |
Nonphysician primary care practitioner |
Includes physician assistants and nurse practitioners. |
Prescribing practitioner |
A practitioner with prescribing privileges, including nurse practitioners, physician assistants and other non-MDs who have the authority to prescribe medications. |
OB/GYN and other prenatal care practitioners |
Includes both of the following.
|
Chemical dependency practitioner |
Includes the following.
|
Mental health practitioner |
Practitioners whom members are able to see for mental health services and who meet any of the following criteria.
|
|
|
Dentist |
Practitioners who hold a Doctor of Dental Surgery (DDS) or a Doctor of Dental Medicine (DMD) degree from an accredited school of dentistry and are licensed to practice dentistry by a state board of dental examiners. |
Appendix 4
Data Element Definitions
|
Admin |
Hybrid |
Research |
Meaning |
Measurement year |
|
|
|
Data year (i.e., year prior to reporting year). For HEDIS 2007, the measurement year is 2006. |
Data collection methodology (administrative or hybrid) |
|
|
|
Method used to collect HEDIS data. Administrative method is from transactional data for the eligible population and hybrid method is from medical record or electronic medical record and transactional data for the sample. |
Eligible population |
|
|
|
|
Eligible population by non-ER/urgent care visits* |
|
|
|
|
Eligible population by ER/urgent care visits* |
|
|
|
|
Number of numerator events by administrative data in eligible population (before exclusions) |
|
|
|
The number of members in the eligible population who met the numerator criteria. |
Current year’s administrative rate (before exclusions) |
|
|
|
Numerator events by administrative data in eligible population ¸ eligible population. |
Minimum required sample size (MRSS) or other sample size |
|
|
|
When selecting the sample, this is the required number of members in the sample. Plans can reduce their samples using Tables 2 and 3 in the sampling guidelines. |
Oversampling rate |
|
|
|
The percentage of additional records needed to replace exclusions and valid data errors in the denominator. The oversample is in 5% increments. Plans that need more than a 20% oversample must contact NCQA. |
Final sample size (FSS) |
|
|
|
Minimum required sample size + oversample. |
Number of numerator events by administrative data in FSS |
|
|
|
Number of members in the final sample size who meet numerator criteria through system/ transactional data. |
|
Admin |
Hybrid |
Research |
Meaning |
Administrative rate on FSS |
|
|
|
Numerator events by administrative data in the FSS ¸ FSS. |
Number of original sample records excluded because of valid data errors |
|
|
|
If the medical record review shows that the member does not meet the criteria outlined in the eligible population, that member is considered a valid data error. |
Number of administrative data records excluded |
|
|
|
Number of members excluded from the denominator because they did not meet the numerator criteria and did meet the exclusion criteria. In this case, the member met the exclusion criteria using system or transactional data. |
Number of medical record data records excluded |
|
|
|
Number of members excluded from the denominator because they did not meet the numerator criteria and did meet the exclusion criteria. In this case, the member met the exclusion criteria using medical record data. |
Number of employee/dependent medical records excluded |
|
|
|
Number of records in the sample excluded because the member was an MCO employee or a dependent of an MCO employee. |
Total exclusions |
|
|
|
The number of records/members excluded due to the optional exclusion criteria. NCQA will use this element for research and analysis. The element will not be used in the calculation of the measure. |
Exclusions for comorbid conditions* |
|
|
|
This is an optional data element in the Inappropriate Antibiotic Treatment for Adults With Acute Bronchitis measure. NCQA will analyze the exclusion criteria. Plans may choose to report their exclusions using this element; however, this element will only be used for analysis and not for calculating the measure. |
Exclusions for competing diagnosis* |
|
|
|
This is an optional data element in the Inappropriate Antibiotic Treatment for Adults With Acute Bronchitis measure. NCQA will analyze the exclusion criteria. Plans may choose to report their exclusions using this element; however, this element will only be used for analysis and not for calculating the measure. |
Exclusions for medication history* |
|
|
|
This is an optional data element in the Inappropriate Antibiotic Treatment for AdultsWith Acute Bronchitis measure. NCQA will analyze the exclusion criteria. Plans may choose to report their exclusions using this element; however, this element will only be used for analysis and not for calculating the measure. |
Records added from the oversample list |
|
|
|
Replacement records for members in the denominator who had an exclusion or valid data error. |
Denominator |
|
|
|
MRSS – exclusions + members added from the auxiliary list. This population is the denominator used to report the measure. |
Numerator events by administrative data |
|
|
|
The number of members in the denominator who met numerator criteria using system or transactional data. |
Numerator events by medical records |
|
|
|
The number of members in the denominator who met numerator criteria using medical record data. |
*These data elements are optional.
|
Admin |
Hybrid |
Research |
Meaning |
Numerator events by non-ER/urgent care visits* |
|
|
|
This is an optional data element for the Inappropriate Antibiotic Treatment for Adults With Acute Bronchitis measure. NCQA will analyze the numerator specification. Plans may choose to report their numerator events using the numerator criteria in the measure; however, this element will only be used for analysis and will not be used in calculating the measure. |
Numerator events by ER/urgent care visits* |
|
|
|
This is an optional data element for the Inappropriate Antibiotic Treatment for Adults with Acute Bronchitis measure. NCQA will analyze the numerator specification. Plans may choose to report their numerator events using the numerator criteria in the measure; however, this element will only be used for analysis and will not be used in calculating the measure. |
Numerator events by therapeutic class* |
|
|
|
This is an optional data element for the Drugs to Avoid in the Elderly measure. NCQA will analyze the various therapeutic classifications. Plans may choose to report their numerator events using the classifications in the measure; however, this element will only be used for analysis and will not be used in calculating the measure. |
Reported rate |
|
|
|
Numerator events by administrative data + numerator events by medical records/denominator. |
Lower 95% confidence interval |
|
|
|
The MCO is 95% sure that the reported rate falls between this lower rate and the upper confidence interval. This is a calculated field in the DST. |
Upper 95% confidence interval |
|
|
|
The MCO is 95% sure that the reported rate falls between this higher rate and the lower confidence interval. This is a calculated field in the DST. |
*These data elements are optional.
|
Administrative |
Measurement year |
|
Data collection methodology (administrative) |
|
Eligible population |
|
Total Exclusions* |
|
Numerator events by administrative data |
|
Reported rate |
|
Lower 95% confidence interval |
|
Upper 95% confidence interval |
|
*These data elements are only included in first and second year administrative measures. The total exclusions will be included in analysis of the measure.
|
Administrative |
Hybrid |
Measurement year |
|
|
Data collection methodology (administrative or hybrid) |
|
|
Eligible population |
|
|
Number of numerator events by administrative data in eligible population (before exclusions) |
|
|
Current year’s administrative rate (before exclusions) |
|
|
Minimum required sample size (MRSS) or other sample size |
|
|
Oversampling rate |
|
|
Final sample size (FSS) |
|
|
Number of numerator events by administrative data in FSS |
|
|
Administrative rate on FSS |
|
|
Number of original sample records excluded because of valid data errors |
|
|
Number of administrative data records excluded |
|
|
Number of medical record data records excluded |
|
|
Number of employee/dependent medical records excluded |
|
|
Records added from the oversample list |
|
|
Denominator |
|
|
Numerator events by administrative data |
|
|
Numerator events by medical records or electronic medical records |
|
|
Reported rate |
|
|
Lower 95% confidence interval |
|
|
Upper 95% confidence interval |
|
|
Appendix 5
Measure Abbreviations
Domain |
Measure Abbreviation |
Measure Name |
EOC |
CIS |
Childhood Immunization Status |
EOC |
AIS |
Adolescent Immunization Status |
EOC |
URI |
Appropriate Treatment for Children With Upper Respiratory Infection |
EOC |
CWP |
Appropriate Testing for Children With Pharyngitis |
EOC |
AAB |
Inappropriate Antibiotic Prescriptions for Adults with Acute Bronchitis |
EOC |
COL |
Colorectal Cancer Screening |
EOC |
BCS |
Breast Cancer Screening |
EOC |
CCS |
Cervical Cancer Screening |
EOC |
CHL |
Chlamydia Screening in Women |
EOC |
OMW |
Osteoporosis Management in Women Who Had a Fracture |
EOC |
CBP |
Controlling High Blood Pressure |
EOC |
BBH |
Beta-Blocker Treatment After a Heart Attack |
EOC |
PBH |
Persistence of Beta-Blocker Treatment After a Heart Attack |
EOC |
CMC |
Cholesterol Management for Patients With Cardiovascular Conditions |
EOC |
CDC |
Comprehensive Diabetes Care |
EOC |
ASM |
Use of Appropriate Medications for People With Asthma |
EOC |
SPR |
Use of Spirometry Testing in the Assessment and Diagnosis of COPD |
EOC |
FUH |
Follow-Up After Hospitalization for Mental Illness |
EOC |
AMM |
Antidepressant Medication Management |
EOC |
ADD |
Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) |
EOC |
GSO |
Glaucoma Screening in Older Adults |
EOC |
LBP |
Use of Imaging for Low Back Pain |
EOC |
ART |
Disease Modifying Anti-Rheumatic Drug Therapy (DMARD) in Rheumatoid Arthritis |
EOC |
MPM |
Annual Monitoring for Patients on Persistent Medications |
EOC |
DAE |
Drugs to Be Avoided in the Elderly |
EOC |
DDE |
Potentially Harmful Drug-Disease Interactions in the Elderly |
EOC |
MSC |
Medical Assistance With Smoking Cessation |
EOC |
FSA |
Flu Shots for Adults Ages 50-64 |
EOC |
FSO |
Flu Shots for Older Adults |
EOC |
PNU |
Pneumonia Vaccination Status for Older Adults |
EOC |
HOS |
The Medicare Health Outcomes Survey |
EOC |
MUI |
Management of Urinary Incontinence in Older Adults |
EOC |
PAO |
Physical Activity in Older Adults |
EOC |
FRM |
Fall Risk Management |
EOC |
OTO |
Osteoporosis Testing in Older Women |
Domain |
Measure Abbreviation |
Measure Name |
AAC |
AAP |
Adults’ Access to Preventive/Ambulatory Health Services |
AAC |
CAP |
Children and Adolescents' Access to Primary Care Practitioners |
AAC |
PPC |
Prenatal and Postpartum Care |
AAC |
ADV |
Annual Dental Visit |
AAC |
IET |
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment |
AAC |
CAT |
Call Answer Timeliness |
AAC |
CAB |
Call Abandonment |
|
||
SEC |
CPA |
CAHPS Health Plan Survey 4.0H, Adult Version |
SEC |
CPC |
CAHPS Health Plan Survey 3.0H, Child Version |
SEC |
CCC |
Children With Chronic Conditions |
|
||
HPS |
YIB |
Years in Business/Total Membership |
|
||
COS |
RDI |
Relative Resource Use for People With Diabetes |
COS |
RAS |
Relative Resource Use for People With Asthma |
COS |
RLB |
Relative Resource Use for People With Acute Low Back Pain |
|
||
UOS |
FPC |
Frequency of Ongoing Prenatal Care |
UOS |
W15 |
Well-Child Visits in the First 15 Months of Life |
UOS |
W34 |
Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life |
UOS |
AWC |
Adolescent Well-Care Visits |
UOS |
FSP |
Frequency of Selected Procedures |
UOS |
IPU |
Inpatient Utilization—General Hospital/Acute Care |
UOS |
AMB |
Ambulatory Care |
UOS |
NON |
Inpatient Utilization—Nonacute Care |
UOS |
MAT |
Discharges and Average Length of Stay—Maternity Care |
UOS |
NEW |
Births and Average Length of Stay—Newborns |
UOS |
MIP |
Mental Health Utilization—Inpatient Discharges and Average Length of Stay |
UOS |
MPT |
Mental Health—Percentage of Members Receiving Inpatient, Day/Night Care and Ambulatory Services |
UOS |
CIP |
Chemical Dependency Utilization—Inpatient Discharges and Average Length of Stay |
UOS |
IAD |
Identification of Alcohol and Other Drug Services |
UOS |
ORX |
Outpatient Drug Utilization |
UOS |
ABX |
Antibiotic Utilization |
|
||
HPD |
BCR |
Board Certification |
HPD |
ENP |
Enrollment by Product Line |
HPD |
EBS |
Enrollment by State |
HPD |
RDM |
Race/Ethnicity Diversity of Membership |
HPD |
LDM |
Language Diversity of Membership |
HPD |
WOP |
Weeks of Pregnancy at Time of Enrollment in the MCO |
Appendix 6
HEDIS
Compliance Audit
Guidelines for Advertising and Marketing
The NCQA HEDIS Compliance Audit program assures both purchasers and consumers of fair and accurate comparisons of MCO performance. NCQA encourages health plans to make their HEDIS Audit status a visible part of their advertising and marketing materials.
References to the terms “advertising,” “advertising material” or “advertising and marketing materials” in the following guidelines include all external communications, including:
Broadcast: Radio, television
Print: Newspapers, magazines, newsletters, directories
Durables: Mugs, t-shirts
Electronic and Web-based materials.
Review and Approval Process
Health plans should thoroughly read these guidelines before producing any advertising and marketing material referencing NCQA or the HEDIS Audit.
An MCO that refers to the HEDIS Audit or any HEDIS data audited by a Certified HEDIS Compliance Auditor must adhere to the following guidelines. Health care organizations are not required to submit advertising materials to NCQA for review and approval; however, these organizations will be held accountable for any violations of this policy.
Contact the NCQA Marketing Department at (202) 955-3509 for additional information or clarification about the guidelines. An organization that encounters advertising or marketing material from its competitors or others that appears inconsistent with these guidelines should notify the NCQA Marketing Department by fax at (202) 955-6428 or e-mail it to marketing@ncqa.org.
How to Advertise an NCQA HEDIS Compliance Audit
An MCO that has undergone an audit may state so, display the audit seal and list all measures audited and reported with an approved rate. The MCO may not advertise or market any measure that is Not Reportable.
Recommended Language
The MCO must use the following statements, alone or in combination, to identify or describe NCQA, the audit process or HEDIS. The organization may also consult the NCQA Web site at www.ncqa.org for additional descriptive information.
The National Committee for Quality Assurance (NCQA), or NCQA…
Is an independent, not-for-profit organization dedicated to measuring the quality of America’s health care.
Is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care organizations, managed behavioral healthcare organizations, physician organizations and credentials verification organizations.
Is committed to providing information on the quality of MCOs. Consumers can easily access MCO NCQA Accreditation statuses and other information on health care quality on the NCQA Web site at www.ncqa.org, or by calling the NCQA Customer Support Center at 888-275-7585.
Is governed by a Board of Directors that includes employers, consumer and labor representatives, MCOs, quality experts, regulators and representatives from organized medicine.
The NCQA mission is to provide information that enables purchasers and consumers of managed health care to distinguish among plans based on quality, thereby allowing them to make better-informed decisions.
The NCQA HEDIS Compliance Audit
The NCQA HEDIS Compliance Audit is a precise, standardized methodology that enables purchasers and consumers to make direct comparisons of MCO performance.
The NCQA audit methodology was developed to assess the standardization of quality performance reporting throughout the health care industry.
The NCQA HEDIS Compliance Audit is a two-part process consisting of an information systems capabilities assessment, which is followed by an evaluation of the MCO’s ability to comply with HEDIS specifications.
HEDIS (Health Plan Employer Data and Information Set)
Since its introduction in 1993, the Health Plan Employer Data and Information Set (HEDIS) evolved to become the gold standard in managed care performance measurement.
Conceived as a way to streamline measurement efforts and promote accountability in managed care, HEDIS measures are now used by approximately 90 percent of all MCOs to evaluate performance in areas ranging from preventive care and consumer experience to heart disease and cancer.
HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care organizations.
Guidelines for Reporting Audit Results
The audit seal |
An
MCO that undergoes an audit receives a seal that may be placed on
advertising and marketing material. The seal signifies that the
MCO’s HEDIS data were audited according to the HEDIS Audit
specifications. The seal clearly indicates the year in which the
data were audited. NCQA provides logo slicks The seal can be placed on advertising or marketing materials that contain some language or information about the HEDIS Audit, which is in accordance with these guidelines. The seal may not be used on durable goods. The seal must not be manipulated in any way and the overall depiction should be consistent with NCQA’s graphical image. |
Required language |
The MCO must use the language below to indicate that its performance measures were audited according to the HEDIS Audit standards. This language should appear in the main text at the beginning of the document and may not be placed in a footnote. |
|
“The NCQA HEDIS Compliance Audit includes the following domains: Effectiveness of Care; Access/Availability of Care; Satisfaction With the Experience of Care; Health Plan Stability; Use of Services; Cost of Care; and Health Plan Descriptive Information. [Health care organization A] has undergone an audit. The following [NCQA performance measures/ HEDIS measures] were deemed reportable according to the NCQA HEDIS Compliance Audit standards.” |
Optional language |
“The audit was conducted by NCQA-Certified Auditors from (name of Licensed Organization), an NCQA-Licensed Organization.” |
NCQA Trademarks
HEDIS® |
The Health Plan Employer Data and Information Set (HEDIS) is a registered trademark of NCQA. The registered trademark symbol should be applied directly after the word “HEDIS.” The organization need only apply the trademark to the first reference of the term “HEDIS” within the written material. At the bottom of the page on which the registered trademark first appears should be a footnote that states: “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).” |
Quality Compass® |
Quality Compass is a registered trademark of NCQA. The registered trademark symbol should be applied directly after the word “Compass.” The organization need only apply the trademark to the first reference of the term “Quality Compass” within the written material. At the bottom of the page on which the registered trademark first appears should be a footnote that states: “Quality Compass® is a registered trademark of the National Committee for Quality Assurance (NCQA).” |
NCQA HEDIS Compliance Audit™ |
NCQA HEDIS Compliance Audit is a trademark of NCQA. The trademark symbol should be applied directly after the word “Audit.” The organization need only apply the trademark to the first reference of the term “NCQA HEDIS Compliance Audit” within the written material. At the bottom of the page on which the registered trademark first appears should be a footnote that states: “NCQA HEDIS Compliance AuditTM is a trademark of the National Committee for Quality Assurance (NCQA).” |
HEDIS Software CertificationSM |
NCQA HEDIS Software CertificationSM is a service mark of NCQA. The service mark symbol should be applied directly after the word “Certification.” The organization need only apply the service mark to the first reference of the term “HEDIS Software Certification” within the written material. At the bottom of the page on which the service mark first appears should be a footnote that states: “HEDIS Software CertificationSM is a service mark of the National Committee for Quality Assurance (NCQA).” |
Certified HEDIS SoftwareSM |
The
NCQA-Certified HEDIS SoftwareSM seal is a service mark
of NCQA. Only vendors whose software achieves certification status
as evidenced by NCQA’s Certification Report receive and may
use the seal for marketing and advertising purposes. The
organization need only apply the service mark to the first
reference of the term “Certified HEDIS Software”
within the written material. “Certified HEDIS SoftwareSM is a service mark of the National Committee for Quality Assurance (NCQA).” |
Noncompliance Policies
Any advertising material or other promotional effort that refers to the HEDIS Audit and violates the Guidelines for Advertising, or which is in any way false or misleading as determined by NCQA, may be grounds for revocation of the organization’s HEDIS Audit status.
NCQA reserves the right to require an organization to withdraw advertising material from distribution immediately or to publish, at the organization’s cost, a retraction or clarification in connection with any false or misleading statements or any violation of these Guidelines for Advertising. Each organization agrees in advance to remedy such violation with the action deemed appropriate by NCQA. In addition, NCQA reserves the right to audit an organization’s NCQA-related advertising and marketing materials at any time.
Appendix 7
Contributors
CONTRIBUTORS
Respiratory Measurement Advisory Panel
David
Au, MD Michael
Cabana, MD Ray
Fabius, MD Ann
Fuhlbrigge, MD Christine
Joseph, PhD Allan
Luskin, MD |
Mo
Mayrides Richard
O’Connor, MD Andy
Stergachis, PhD, RPh Tom
Stibolt, MD Arthur
Turk, MD Kevin
Weiss, MD (Chair) |
Behavioral Health Measurement Advisory Panel
Joann
Albright, PhD John
Bartlett, MD Bruce
Bobbitt, PhD, LP Audrey
Burnam, PhD Vijay
Ganju, PhD Eric
Goplerud, PhD Katherine
Grimes, MD, MPH
|
Richard
Hermann, MD, MS Constance
Horgan, ScD John
Ludden, MD David
Mrazek, MD, FRC Psych Harold
Pincus, MD Mike
Quirk, PhD (Chair) Sarah
Wattenberg, LCSW-C (Liaison) |
Cardiac Expert Panel
Neil
Brooks, MD Jennifer
Daley, MD William
Dalsey, MD Joseph
Drozda, MD Barbara
Fleming, MD Frederick
Glover, MD Nancy
Houston-Miller, RN, BSN Harlan
Krumholz, MD Thomas
Lee, MD Barbara
McNeil, MD, PhD George
Mensah, MD Joseph
Messner, MD |
Susan
Nedza, MD Marlene
Miller, MD, MSc Diana
Ordin, MD, MPH David
Roffman, PhD Sidney
Smith, MD George
Sopko, MD John
Spertus, MD Derek
van Amerongen, MD Doug
Wood, MD (Chair) Albert
Wu, MD |
National Diabetes Quality Improvement Alliance Operations Group
Rhoda
Cobin, MD, FACE Michael
M. Engelgau, MD Judith
Fradkin, MD Theodore
Ganiats, MD Sheldon
Greenfield, MD (Chair) Richard
Kahn, PhD Karen
Kmetik, PhD |
Jerod
Loeb, PhD Gregory
Pawlson, MD, MPH Leonard
Pogach, MD Sheila
Roman, MD James
L. Rosenzweig, MD
|
Geriatric Measurement Advisory Panel
Wade
Aubry, MD Arlene
Bierman, MD, MS David
Buchner, MD, MPH Rosaly
Correa-de-Araujo, MD, MSc, PhD Joyce
Dubow Terry
Fulmer, PhD, RN Peter
Hollmann, MD |
Jerry
Johnson, MD Steven
Philips, MD Cheryl
Phillips, MD, CMD Eric
G. Tangalos, MD, MPH Joan
Weiss, PhD, RN, CRNP Neil
Wenger, MD Desurai
Wilson |
Pediatric Health Plan Assessment Task Force
Blake
Caldwell, MD, MPH Kathryn
Coltin, MPH Christine
Crofton, PhD Cheryl
Damberg, PhD Mary
Fermazin, MD, MPA Christopher
Forrest, MD, PhD Shirley
Girouard, PhD, RN Lewis
Gregory, MD Neal
Halfon, MD, MPH Katharine
Hiltunen, BSN, MBA |
Charles
Homer, MD, MPH Sherrie
Kaplan, PhD Paul
Newacheck, PhD Robert
H. Pantell, MD James
Perrin, MD Lisa
Simpson, MB, BCh, MPH, FAAP Lori
Stephenson Jeffrey
L. Susman, MD Peter
C. van Dyck, MD, MPH |
Pregnancy and Neonatal Care Expert Panel
William
C. Andrews, MD Thomas
J. Benedetti, MD Carolyn
M. Clancy, MD Patricia
A. Dailey Eric
C. Eichenwald, MD Mary
Kay Holleran William
J. Hueston, MD Marilyn
C. Jones, MD |
Milton
Kotelchuck, MPH, PhD George
A. Little, MD Teresa
Marchese, CNM, PhD Mark
D. Pearlman, MD Laura
E. Riley, MD Michael
G. Ross, MD, MPH Lynn
S. Wilcox, MD, MPH Stanley
Zinberg, MD, MS, FACOG |
Women’s Health Measurement Advisory Panel
William
C. Andrews, MD (Chair) David
F. Archer, MD Grant
P. Bagley, MD, JD Carolyn
M. Clancy, MD Karen
Scott Collins, MD Mary
Kay Holleran, RN Debra
R. Judelson, MD Joseph
Kaczmarczyk, DO, MPH |
Dorothy
H. Mann, PhD, MPH Saralyn
Mark, MD Elizabeth
A. Mort, MD, MPH Debra
L. Ness, MS Robin
S. Richman, MD, FACOG Carol
W. Saffold, MD Carol
Weisman, PhD (Co-Chair) Lynne
S. Wilcox, MD, MPH |
Efficiency Measurement Advisory Panel
Kathleen Borowsky, RN, BA, MBA Aetna Health Analytics Team Laurie Case CIGNA Healthcare Kathleen Curtin Univera Healthcare Dan Dunn, PhD IHCIS-Symmetry Elliott Fisher, MD, MPH Dartmouth Medical School Center for the Evaluative Clinical Sciences Irene Fraser, PhD Agency for Healthcare Research and Quality (AHRQ) Kyle
Grazier, PhD Trent
Haywood, MD, JD |
Randy
Herman, FSA, MAAA David
Knutson, PhD Mark
Rattray, MD Richard
Salmon, MD, PhD Ron
Stettler Matt
Stiefel, MPA Joe
Woods Timothy
Zeddies, MHSA, PhD |
Technical Advisory Group
Steven
Asch, MD William
Briscoe, CHCA Kathryn
Coltin, MPH Richard
Dixon, MD, FACP Joe
Ensor, Jr., PhD Carlos
Hernandez, CHCA Harmon
Jordan, ScD |
Elizabeth
McGlynn, PhD (Chair) James
Murray, PhD Patrick
Roohan Lynne
Rothney-Kozlak, MPH William
Munier, MD Natan
Zapiro |
HEDIS Expert Audit Methodology Panel
Peggy
Barth, RN Elaina
Coyne, CNP, MHA, CHCA Lawrence
McLaughlin, MBA, CHCA Elizabeth
Everitt, MA, CHCA Carlos
Hernandez, CHCA Herman
Jenich, MPP, CHCA Peggy
Ketterer, RN, BSN, CHCA |
Tina
Kind, MBA, CHCA Patricia
Martin, MA, CHCA Paul
Mertel, PhD, FACHE, CHCA Robert
Oakleaf, MA, CHCA Anu
Sajja, MPH, CHCA James
Tan, MD, MPH Jean
Vertefeuille, MA, CHCA |
HEDIS Expert Coding Panel
Denene
Harper DeHandro
Hayden Patience
Hoag, RHIT, CHCA, CCS, CCS-P, CPC Terrie
Krinsky, CCS Michelle
Lefebvre, RN, BSN |
Nelly
Leon-Chisen, RHIA Tammy
Marshall, LVN Craig
Thacker Vicky
Turner-Howe, RHIT |
HEDIS Expert Laboratory Panel
Gary
Assarian, DO Kathy
Borowsky, RN, MBA Cynthia
L. Brown, CHCA Jeffrey
Bush Brandyn
S. Kirkland Katherine
Mercer John
Richard Papp, MS, PhD |
C.
Anne Pontius, MBA, MT (ASCP), CMPE G.
Gregory Raab, PhD Miranda
Slade Susan
Strouse, MT (ASCP) Ann
M. Vannier, MD |
HEDIS Expert Policy Panel
Andy
Amster, MSPH Laura
Ashton, MS, RN Kathleen
Curtin, RN, MBA, NP Barbara
Dailey, RN, BSN, MS, CPHQ Scott
Fox Bradley
Gilbert, MD |
Leslie
Stokan, MSN Joan
Kostusiak, RN, MS, PNP Sharon
Ricciuti Mahil
Senathirajah, MBA, CHCA John
Strauss, MD Eric
Sullivan, MBA, MS |
HEDIS Expert Pharmacy Panel
Michael
Arizpe, RPh Mark
Brueckl, RPh, MBA Chris
Cawley, RN Carey
Cotterell, RPh Marissa
Finn, MBA |
Gerry
Hobson Kevin
Park, MD, CHCA Phillip
Parsatoon, RPh Dawn
Shojai-Sisneroz, PharmD, PhD |
Access and Service Measurement Advisory Panel
John
Anton, PhD Abby
Block, MA, MSW, MBA Christine
Crofton, PhD Sam
Ho, MD David
Hopkins, PhD Anthony
Kotin, MD Faye
Laatch |
Terry
Leid, PhD Jean
LeMasurier Mark
Murray, MD, MPA Debra
Patterson John
Rust Michael
Schwed Michael
Thompson, FSA, MAAA |
| File Type | application/msword |
| File Title | Appendix 1 |
| Author | Lacourci |
| Last Modified By | CMS |
| File Modified | 2007-01-31 |
| File Created | 2007-01-31 |