Healthcare Effectiveness Data and Information Set (HEDIS ...

Healthcare Effectiveness Data and Information Set (HEDIS)

Report Year 2020 - Measurement Year 2019

Summary of Performance

June 2020

Table of Contents NCQA’s Notice of Copyright and Disclaimers ................................................................................ 3

Composite HEDIS Performance by Reporting Year ....................................................................... 4

Composite HEDIS Performance; Reporting Year 2020 Baseline ................................................... 5

Summary of Performance by Region ............................................................................................ 6

Regional Distribution of Measures by Percentile Ranking ............................................................ 6

Measures At or Above the High Performance Level (HPL) - 90th Percentile ................................ 6

Measures Below the Minimum Performance Level (MPL) - 50th Percentile ............................... 6

Performance Relative to Quality Compass® Medicaid Benchmarks ............................................. 7

Percentage Difference from Prior Year ......................................................................................... 8

Percentile Ranking Change from Prior Year .................................................................................. 9

Summary of Performance by County .......................................................................................... 10

Distribution of Percentile Rankings by County............................................................................ 10

Northeast Region: Modoc, Trinity, Siskiyou, Shasta and Lassen Counties ................................. 11

Northwest Region: Del Norte and Humboldt Counties............................................................... 12

Southeast Region: Solano, Yolo and Napa Counties ................................................................... 13

Southwest Region: Lake, Marin, Mendocino and Sonoma Counties ......................................... 14

Summary of Measures in the Primary Care Provider Quality Improvement Program (PCP QIP) 15

Measurement Year 2019 Measurement Set Descriptions .......................................................... 16

Quality Improvement Initiatives - HEDIS Score Improvement .................................................... 20

Partnership HealthPlan of California Report Year 2020 - Measurement Year 2019

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA. P a g e | 3

NCQA’s Notice of Copyright and Disclaimers The source for certain health plan measure rates and benchmark (averages and percentiles) data ("the Data") is Quality Compass® [2019] and is used with the permission of the National Committee for Quality Assurance ("NCQA"). Any analysis, interpretation or conclusion based on the Data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation or conclusion. Quality Compass is a registered trademark of NCQA. The Data comprises audited performance rates and associated benchmarks for Healthcare Effectiveness Data and Information Set measures ("HEDIS®") and HEDIS CAHPS® survey measure results. HEDIS measures and specifications were developed by and are owned by NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties or endorsement about the quality of any organization or clinician who uses or reports performance measures, or any data or rates calculated using HEDIS measures and specifications, and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in Quality Compass and the Data and may rescind or alter the Data at any time. The Data may not be modified by anyone other than NCQA. Anyone desiring to use or reproduce the Data without modification for an internal, noncommercial purpose may do so without obtaining approval from NCQA. All other uses, including a commercial use and/or external reproduction, distribution or publication, must be approved by NCQA and are subject to a license at the discretion of NCQA. © [2020] National Committee for Quality Assurance, all rights reserved. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).



Composite HEDIS Performance by Reporting Year The below graph represents PHC’s regional and plan-wide composite score relative to prior year including only measures where DHCS holds Managed Care Plans accountable for and remained in the measurement set over the last three years. The methodology for calculating is noted below, along with the measures included/excluded from the calculations. Score = Points Earned/ Possible Points. Points are awarded per measure based on percentile ranking: 1 point for <10th percentile, 2 for the 10th, 3 for the 17.5, 4 for the 25th, 5 for the 37.5, 6 for the 50th, 7 for the 62.5, 8 for the 75th, 9 for the 82.5, and 10 for the 90th

Note: The MPL changed from the 25th percentile in RY2019 to the 50th percentile in RY2020.

HEDIS MY 2018 / RY 2019 - Total Points Earned: 239 Points out of 400 Total Points (10 measures included)

HEDIS MY 2019 / RY 2020 - Total Points Earned: 279 Points out of 400 Total Points (10 measures included)

Measures included due to being held accountable to MPL for both HEDIS MY 2018 / RY 2019 and HEDIS MY 2019 / RY 2020: AMR, BCS, CBP, CCS, CDC-H9, CDC-HT, IMA-2, PPC-Pre, PPC-Pst, W-34

Measures excluded due to NOT being held accountable to MPL for HEDIS MY 2018 / RY 2019 or HEDIS MY 2019 / RY 2020: AMB-ED, CAP-1219, CAP-1224, CAP-256, CAP-711, DSF, MPM-ACE, MPM-DIU, PCR

Measures excluded due to no longer being reported for HEDIS RY 2020: AAB, AMB-OP, CDC-BP, CDC-E, CDC-H8, CDC-N, CIS-3, DSF, LBP, WCC-N, WCC-PA



Composite HEDIS Performance; Reporting Year 2020 Baseline The below graph represents PHC’s regional and plan-wide composite score including all measures for which DHCS holds Managed Care Plans Accountable. Note: The MPL changed from the 25th percentile in RY2019 to the 50th percentile in RY2020.

HEDIS MY 2019- Total Points Earned: 475 out of 720 total points (18 measures included) Measures included due to being held accountable to MPL for the NEW HEDIS MY 2019 MCAS

Measurement Set: AWC, ABA, AMM-Acute, AMM-Cont, AMR, BCS, CBP, CCS, CIS-10, CHL, CDC-Testing, CDC-Poor Control, IMA-2, PPC-Pre, PPC-Post, WCC-BMI, W15, W34

Measures excluded due to NOT being held accountable to MPL for HEDIS MY 2019: AMB-ED, ADD-initiation, ADD-C&M, CAP, CCW, CCP, CDF, COB, DEV, HVL, MPM Ace/Arb, MPM Diu, OHD, PCR



Summary of Performance by Region

Measures At or Above the High Performance Level (HPL) - 90th Percentile

Measures Below the Minimum Performance Level (MPL) - 50th Percentile Note: The MPL changed from the 25th percentile in RY2019 to the 50th percentile in RY2020.

*- Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures). NOTES: Report excludes measures reported to DHCS where DHCS does not hold Managed Care plans accountable for meeting specific performance targets (i.e. Plan-wide All Cause Readmission, Ambulatory Care, Children & Adolescents Access to Primary Care Practitioners, Screening for Clinical Depression).

Regional Distribution of Measures by Percentile Ranking



Performance Relative to Quality Compass® Medicaid Benchmarks Note: The MPL changed from the 25th percentile in RY2019 to the 50th percentile in RY2020.

*- Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures).



Percentage Difference from Prior Year

*- Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures). CDC-HbA1c Poor Control (>9) – Decrease indicates performance improvement. Note: New measures excluded due to it being the first year that PHC is reporting: ABA – Adult BMI Assessment, AMM – Acute Phase, AMM – Continuations Phase, AWC – Adolescent Well-Care Visits, CHL – Chlamydia Screening in Women, CIS Combo 10, W15 Six or more well child visits, WCC BMI. RY 2020 will be PHC’s baseline reporting year for these measures.



Percentile Ranking Change from Prior Year Note: The MPL changed from the 25th percentile in RY2019 to the 50th percentile in RY2020.

*- Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures). Note: New measures excluded due to it being the first year that PHC is reporting: ABA – Adult BMI Assessment, AMM – Acute Phase, AMM – Continuations Phase, AWC – Adolescent Well-Care Visits, CHL – Chlamydia Screening in Women, CIS Combo 10, W15 Six or more well child visits, WCC BMI. RY 2020 will be PHC’s baseline reporting year for these measures.



Summary of Performance by County

Distribution of Percentile Rankings by County Note: The MPL changed from the 25th percentile in RY2019 to the 50th percentile in RY2020.



Northeast Region: Modoc, Trinity, Siskiyou, Shasta and Lassen Counties





Northwest Region: Del Norte and Humboldt Counties





Southeast Region: Solano, Yolo and Napa Counties





Southwest Region: Lake, Marin, Mendocino and Sonoma Counties





Summary of Measures in the Primary Care Provider Quality Improvement Program (PCP QIP) included in the Managed Care Accountability Set (MCAS) for Medi-Cal Managed Care Plans Measurement Year 2019 | Reporting Year 2020.

HEDIS Measures 2019

PCP QIP Measures

2020 PCP QIP

Measures

Alternate Measure in PCP QIP Measures

Adolescent Well-Care Visits (AWC) Monitoring Measure Only in 2020 due to COVID-19

Adult Body Mass Index (BMI) Assessment (ABA) Antidepressant Medication Management: Acute Phase Treatment (AMM-Acute)*

Antidepressant Medication Management: Continuation Phase Treatment (AMM-Cont)*

Asthma Medication Ration (AMR)* X X

Breast Cancer Screening (BCS)* X Monitoring Measure Only in 2020 due to COVID-19

Cervical Cancer Screening (CCS) X Monitoring Measure Only in 2020 due to COVID-19

Childhood Immunization Status (CIS) – Combo 10 X Expanded from Combo 3 in QIP 2019

Chlamydia Screening in Women (CHL)* Comprehensive Diabetes Care (CDC-H9) – HbA1c Poor Control (>9.0%)*

QIP measures: Good Control, HbA1c ≤9.

Comprehensive Diabetes Care (CDC-HT) – HbA1c Testing

Controlling High Blood Pressure (CBP) X X

Immunizations for Adolescents (IMA) – Combo 2 X Monitoring Measure Only in 2020 due to COVID-19

Prenatal and Postpartum Care (PPC) – Postpartum Care Similar measure in Perinatal QIP.

Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care

Similar measure in Perinatal QIP.

Weight Assessment and Counseling for Children/Adolescents (WCC) – BMI Assessment

Well-Child Visits in the First 15 Months of Life: Six or More Well-Child Visits (W15) X

Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) X

Monitoring Measure Only in 2020 due to COVID-19

*-Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures). PCP QIP Measurement Set: http://www.partnershiphp.org/Providers/Quality/Pages/PCPQIPLandingPage.aspx



Measurement Year 2019 Measurement Set Descriptions HEDIS Measure Measure Indicator Measure Definition

Adult BMI Assessment (ABA)

• Percentage of members 18-74 years With documented body mass index in measurement year or prior year

The percentage of members 18–74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.

*Antidepressant Medication Management (AMM)

• Effective Acute Phase Treatment

• Effective Continuation Phase Treatment

The percentage of members 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression and who remained on an antidepressant medication treatment.

• Effective Acute Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 84 days (12 weeks).

• Effective Continuation Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 180 days (6 months).

*Asthma Medication Ratio (AMR)

• The ratio of controller medications >0.50

The percentage of members 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.

• Total. The sum of the age stratifications (ages 5–64) as of December 31 of the measurement year.

Adolescent Well-Care Visits (AWC)

• Percentage of enrolled members 12-21 years with one visit in the measurement year

The percentage of enrolled members 12–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.



HEDIS Measure Measure Indicator Measure Definition

*Breast Cancer Screening (BCS)

• Percentage of women 52-74 years with screening as of 12/31 of the measurement year

The percentage of women 52–74 years of age who had a mammogram to screen for breast cancer as of December 31 of the measurement year.

Controlling High Blood Pressure (CBP)

• Percentage of members 18-85 years with hypertension & BP <140/90mm Hg during measurement year

The percentage of members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year.

Cervical Cancer Screening (CCS)

• See measure definition

The percentage of women 21–64 years of age who were screened for cervical cancer using either of the following criteria:

• Women 21–64 years of age who had cervical cytology performed within the last 3 years

• Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years

• Women 30–64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) cotesting within the last 5 years

Comprehensive Diabetes Care (CDC)

• Hemoglobin A1c (HbA1c) testing

• HbA1c poor control (>9.0%)

The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the Measure Indicators performed.

• Hemoglobin A1c (HbA1c) testing. An HbA1c test performed during the measurement year.

• HbA1c poor control (>9.0%). The most recent HbA1c level is >9.0% or is missing a result, or if an HbA1c test was not done during the measurement year.




*Chlamydia Screening in Women (CHL)

• Percentage of women 16-24 Years, sexually active with one test during measurement year

The percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.

• Total. The sum of the age stratifications.

Childhood Immunization Status (CIS) • Combination 10

The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.

• Combination 10. Children who have had all ten indicators (DTaP, IPV, MMR, HiB, HepB, VZV, PCV, HepA, RV and Influenza).

Immunizations for Adolescents (IMA) • Combination 2

The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. The measure calculates a rate for each vaccine and two combination rates.

• Combination 2. Adolescents who have had all three indicators (meningococcal, Tdap and HPV).




Prenatal and Postpartum Care (PPC)

• Timeliness of Prenatal Care

• Postpartum Care

The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care.

• Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization.

• Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.

Well-Child Visits in the First 15 Months of Life (W15)

• Six or more well-child visits

The percentage of members who turned 15 months old during the measurement year and who had well-child visits with a PCP during their first 15 months of life.

• Six or more well-child visits. Seven separate numerators are calculated, corresponding to the number of members who received 0, 1, 2, 3, 4, 5, 6 or more well-child visits.

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)

• Percentage of members 3-6 years With one or more visits during measurement year

The percentage of members 3–6 years of age who had one or more well-child visits with a PCP during the measurement year.

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)

• BMI Percentile Documentation

The percentage of members 3–17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year.

• BMI Percentile Documentation. Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.

*-Administrative Measures. The entire eligible population is used in calculating performance (versus a systematic sample drawn from the eligible population for the hybrid measures).



Quality Improvement Initiatives - HEDIS Score Improvement

PHC’s Quality Improvement organization wide goals for 2019-2020 included three main focus areas: Well-Child Visits (W34), Asthma Medication Ratio (AMR) and Prenatal Postpartum Engagement Work Group (PPEW). Based on the measure(s) of focus, there was a cross-functional work group including department representation from: Health Analytics, Care Coordination, Claims, Health Education, Medical Directors, Pharmacy, Population Health Management, Provider Relations, and Quality Improvement. To measure success, work groups were assigned goals to achieve by June 30, 2020.

Well Child Visits (W34) • Workgroup Aim, Objectives and Focus Areas:

o Aim: Measurement year 2019 HEDIS results for the W34 measure will be above the 50th percentile for at least 2 regions and above the 25th percentile for all regions. Outcome: Based on preliminary HEDIS MY 2019, the goal was met with the

2 southern reporting regions performing above the 50th percentile and the 2 northern reporting regions above the 25th percentile.

o Objective: Drive improvement in Well Child visits through focus on the many activities around well child visits and inform the HEDIS Score Improvement Workgroup about efforts.

o Focus Areas: The workgroup identified over 20 deliverables that would be tracked across the following focus areas: Inform Well Child Work: PHC internal information, education and data

analysis. Track PHC Operational Changes: Follow operational changes that will

impact and improve well child performance rates (i.e. QIP, Birthday Club, ePrompts).

Deploy Resources to Optimize Provider Ability to Improve: Create and update resources available to providers that will impact and improve well child rates (i.e. training, provider informing materials, member facing materials available for providers to give to patients).

Conduct Performance Improvement Projects: Work with provider partners to conduct quality improvement projects around well child.

Employ PHC-Driven Member Engagement Strategies: Identify a Plan-Wide Strategy for Member In-Reach and Outreach.

• Accomplishments Contributing to Improved Performance:

o Well child measure insights were added into the provider scorecard developed by the PHC Claims department with QI were added in 25 NR provider scorecards.

o Conducted assessment of existing health education materials related to well child. Next fiscal year will focus on development of new materials for identified gaps.



o The Birthday Club targeting 3-6 year old members was implemented across PHC’s Northern Region. Significant efforts made towards deploying plan-wide, including vendor evaluation.

o Provider trainings completed, resources developed and updated (Quality Measure Highlights, well care dashboard, pocket guide, QIP program, Accelerated Learning 4/15/20 session).

o Initiated Priority and Health Equity PIPs, focusing on well-child visit measures W34 and W15, respectively.

Asthma Medication Ratio • Workgroup Aim and Objectives:

o Aim: Partnership HealthPlan of California (PHC) aims to increase Asthma Medication Ratio (AMR) Regional Performance composite scores by 5% from mid-year 2018 to March 2020 (Note, this goal was revised to exclude impact from COVID-19). This goal was exceeded with a 6.28% increase. Per reporting in May 2020, the AMR plan-wide composite score improved from baseline of 59.97% to 66.25%.

o Objectives: Increase prescriber’s awareness of their patient’s asthma prescription

activity. New prescriptions and refills for all asthma medications within measured timeframe.

Increase member’s knowledge and engagement with managing their asthma and asthma medications, including appropriately coding for co-morbidities and alternative diagnoses.

Increase community pharmacists’ knowledge for the AMR HEDIS measure and promote engagement to improve AMR through patient consultation, increase controller medication dispensing, and monitor and reduce rescue inhaler dispensing as clinically appropriate.

Increase prescription fills, including 90 day supply fill, for asthma controller medication.


o Developed Academic Detailing Materials, which included measure specifications and best practices; to facilitate the education of provider organization.

o In collaboration with a Medical Director, Pharmacist, and QI representative, provided on-site education to over 15 Provider Sites and 7 Pharmacies.

o Developed custom reports on provider sites that received academic detailing to track progress on AMR rates.

o Created community outreach materials to educate members.



Prenatal and Postpartum Engagement Work Group (PPEW) • Workgroup Aim and Objectives:

o Aim: The PPEW team will ensure standardized engagement visits with 15 large perinatal providers by June 30, 2020.

o Objectives: All OB/Perinatal quality measures will be at or above the 50th percentile of Medicaid plans nationally, starting with MY 2019 (this year). These measures are grouped as follows: Initial OB visit, timely, depression screen Post-partum visits, timely, depression screen, contraception Vaccinations: TDap and Flu Hospital: Elective preterm delivery, NTSV C-section


o Developed core curriculum and message to share with practices across the regions with focus on: Quality Prenatal Care Current regional and local data PHC resources to support optimal outcomes.

o By June 30th, 2020 PPEW group will have provided site specific education to 22 provider organizations of which 15 are large organizations.

o Developed, distributed and received responses back from 25 sites that participated in the Perinatal.

o Practice Survey. The survey was developed to assess overall volume of perinatal services for Medi-Cal eligible patients in our network.

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