October HEDIS report shows results variable by domain

The most recent HEDIS report from the Colorado Department of Health Care Policy and Financing shows that Colorado Medicaid’s weighted averages indicate low program performance statewide compared to national standards. 

HEDIS (Healthcare Effectiveness Data and Information Set) 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 plans. The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking, asthma and diabetes. HEDIS also includes a standardized survey of consumers’ experiences that evaluates plan performance in areas such as customer service, access to care, and claims possessing.


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The report looks at a number of categories to determine performance measures and determine where improvement is needed. The results were variable by domain. 

The report also analyzes performance for Denver Health Medical Plan (DHMP) and Rocky Mountain Health Plans Medicaid Prime. HEDIS 2019 MCO rates and the statewide weighted average rates were compared to the corresponding national HEDIS benchmarks. 

Performance for the MCOs in the Pediatric Care domain demonstrated opportunities for improvement, with 13 of 20 (65.0 percent) measure rates for DHMP falling below the 50th percentile and all seven reportable rates for RMHP Prime below the 25th percentile, the report explains. In Colorado, the rate of adolescents with immunizations, and the rate of treatment for adolescents with respiratory infections was in the 75th percentile nationwide. 

From 2018 to 2019 none of the immunization categories showed a significant difference in performance. Most categories showed an increase or decrease in immunization rates of 1-2%. 

The rate of adolescent well-care visits, however, increased dramatically from 2018 to 2019. This improvement was both in terms of physical and mental health care. 

When looking at access to care and preventative screenings, the state falls below the 50th percentile, showing clear room for improvement. 

 “The MCOs and the Department should conduct root cause analyses for the low access to care rates to determine the nature and scope of the issue (e.g., are the issues related to barriers to accessing care, a lack of family planning service providers, or the need for improved community outreach and education). Once the root causes are identified, the MCOs and the Department should work with providers and members to establish potential performance improvement strategies and solutions to increase the access to care rates,” the report suggests. 

It is noteworthy that in the preventative screening category, the state fell into the bottom 25th percentile while several non-recommended screenings for women and children were in the 75th percentile categorically. The report explains that the state should focus on improving the low performance of breast cancer screenings in this category specifically. 

When looking at mental and behavioral health results, the state fell into the bottom 50th percentile. Within this category, however, the state showed strength with monitoring young members on antipsychotics. 

The report identified a number of categories that require additional improvement for those with chronic illnesses. 

“For the Living With Illness domain, only 5 of 23 (21.7 percent) of DHMP’s measure rates and 4 of 22 (18.2 percent) of RMHP Prime’s measure rates were above the 50th percentile. Both MCOs demonstrated opportunities to improve the care management of members with diabetes, as evidenced by the low rates of testing for HbA1c levels, retinal disease, and nephropathy, along with the low prescribing rates of statin medication. Further, the MCOs indicated improvement is needed related to the medication management for members with other chronic conditions (e.g., cardiovascular disease, asthma, COPD),” the report explains. 

The recommendations in this report can be used to improve access to care in each category. The report is compiled annually.