Performance Measures Resources
Health Net Access (HNA) contracts with the Arizona Health Care Cost Containment System (AHCCCS) and reports required quality and performance metrics to ensure members receive a high quality of care. Metrics are identified by AHCCCS and associated with specifications, primarily the Health Effectiveness Data and Information Set (HEDIS) and the Centers for Medicare & Medicaid Services (CMS) Core Set.
What is HEDIS?
HEDIS is the Healthcare Effectiveness Data and Information Set defined by the National Committee for Quality Assurance (NCQA). It is the gold standard in healthcare performance measurement and consists of over 70 measures affecting mortality and morbidity. The use of HEDIS measures is an exciting opportunity to show the quality of our services. Specifications for HEDIS measures are proprietary and must be purchased through the National Committee for Quality Assurance (NCQA). More information is available on the NCQA website at http://www.ncqa.org/homepage.
What is CMS Core?
The Center for Medicaid and CHIP Services (CMCS) developed a set of core measures reflective of an overall quality strategy. The measure specifications are available online at https://www.medicaid.gov/medicaid/quality-of-care/index.html
HNA and Performance Measures
HNA is responsible for meeting the Minimum Performance Standard (MPS) on 48 performance measures selected by AHCCCS that are a combination of HEDIS and CMS Core Measures. Measures apply to our adult and child populations of Title 19 acute care members. Please see the attached measure list and reference guide for more information on measures, source and MPS.
- Most measures are administrative, meaning they are based on claims data. Timely and accurate billing has a large effect on the measures.
- Coordinate care effectively with all involved practitioners, hospitals and agencies to ensure members receive appropriate services. This includes rapport building and efficient information sharing.
- Know your scores. Monitor your data and look for multiple measures that could be impacted by a single intervention. An example would be development of a chronic disease management program for diabetes. This could impact utilization as well as preventive screenings to improve the health of our members.
- Hit the low hanging fruit. Identify measures with the fewest members in need of engagement for a service and conduct outreach.
- Avoid missed opportunities. Ensure each appointment addresses all care gaps to improve member care. An example would be conducting an EPSDT visit when a member attends and appointment due to injury or illness.
Quality Improvement Contacts
The HNA Quality Improvement Department is here to help! Feel free to reach out with questions or to request a technical assistance session. Our performance measure experts can be reached at HNAQualityManagement@centene.com.