New Hampshire HEDIS Measure Topic Reports

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					                  New Hampshire
                  HEDIS Measure
                   Topic Reports

Presentation to the New Hampshire CHIS
  Users Group Meeting, June 27, 2006
                What is HEDIS?
• Health Plan Employer Data and Information Set
• 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 plans.
• Based upon national guidelines for HEDIS reporting set
  by National Committee for Quality Assurance (NCQA)
• Under New Hampshire law (RSA 420-G:11, II-a) all New
  Hampshire carriers who collect HEDIS data must
  annually submit the HEDIS information to the state.
• National Report- The State of Health Care Quality

June 27, 2006
            Understanding the Data:
• Does not include Medicaid, Medicare, and the
• Benchmark data includes an average of:
   –   National - 262 health plans
   –   New England (NH, ME, MA, CT, RI, VT) - 26 health plans
   –   Northern New England (NH, ME, VT) - 11 health plans
   –   New Hampshire - aggregate of 3 plans:
        • Anthem - 210,807 member years
        • Harvard - 42,242 member years
        • CIGNA - 126,598 member years
• Time Period: data year 2004 / reporting year 2005.

 June 27, 2006
                Health Topics Reports:
• New Hampshire data presented in the reports
  aggregates results from three NH HealthPlans.
     – Data are weighted by member years.
• National and regional benchmarks are included.
• Report topics include:
     –   Child and Adolescent health.
     –   Women’s Health Care.
     –   Comprehensive Diabetes Care.
     –   Mental Health & Substance Abuse.
     –   Hospital Utilization.

June 27, 2006
HEDIS Measure Results Reviewed
                in The Topic Summaries:
• Childhood and Adolescent Health
    – Access to PCP, Immunizations, Testing for Pharyngitis, Treatment of
      URI, Prescription of Asthma Medications.
• Comprehensive Diabetes Care
    – Screenings and tests: eye exams, blood glucose (HbA1c), serum
      cholesterol level (LDL-C), kidney disease screening, Clinical Outcomes:
      poor HbA1c, LDL <100mg.dL.
• Women’s Health Care
    – Breast cancer screening, Cervical cancer screening, Chlamydia
      screening, Prenatal care and postnatal care.
• Mental Health & Substance Abuse
    – Antidepressant Medication Management, Follow-up after Hospitalization
      for Mental Illness, Mental Health Utilization, Chemical Dependency
• Hospital Utilization
    – Inpatient Utilization, Ambulatory Outpatient Utilization, Inpatient
      Utilization for Maternity Care, Inpatient Utilization for Newborn Care.

 June 27, 2006
Sample of Topic Report Content
         Mental Health & Substance Abuse Report:

 • Overall introduction to the topic.
 • Executive summary of Key Findings for all
   HEDIS measures related to this topic.
 • New Hampshire results and comparisons to
   benchmarks for each HEDIS measure.
      – Introduction to the measure.
      – Specific definition for the measure.
      – Results in graphics and written summaries.

 June 27, 2006
          Follow-up After Hospitalization for Mental Illness
          Most ser ious ca ses of m en t a l illn esses a r e h ospit a lized for det er m in e pr oper dia gn osis,
          obser va t ion , pr escr ipt ion of a ppr opr ia t e m edica t ion s, a nd r efer r a l t o out pa t ient m en t a l
          h ea lt h ser vices, su ch a s cou nselin g. Ser ious ca ses in clude people wh o pose a t h r ea t t o h u r t
          t h em selves or com m it su icide. Appr opr iat e follow-up ca r e a ft er hospit a liza t ion ca n r edu ce
          t h e r at e of r e-hospit a liza t ion a nd ensu r e pat ient s ar e accessin g n eeded ser vices (Th e St a t e
          of H ea lt h Ca r e Qu alit y, NCQA, 2005).

                                      Percent of Patients Hospitalized for Mental Health
                                      Conditions who Received Follow-up, HEDIS 2004

                         Follow-up within 30    83%
                                days            76%

                           Follow-up within 7   65%
                                 days           56%

                                            0.0%       20.0%     40.0%      60.0%      80.0%      100.0%

                              New Hampshire           National    New England        N. New England

          HEDIS Measurement Definition
          P er cen t a ge of h ea lt h pla n m em ber s a ged 6 year s of a ge a n d older wh o r eceived in pat ien t
          t r ea t m en t for a m ent a l h ea lt h disor der a n d who h a d a n am bu la t or y or ot h er specified t ype
          of follow-up visit wit h in 7 a n d 30 da ys a ft er h ospit a l disch a r ge.

          Resu lt s
          New H am psh ir e’s per cen t a ge of pat ien t s wit h am bu la t or y follow-u p a ft er a h ospit a lizat ion
          for a m en t a l h ea lt h condit ion was 70% wit h in 7 da ys a ft er h ospit a lizat ion , a nd 89% for
          wit h in 30 da ys. Th ese r a t es fa vor a bly exceeded bot h t h e n a t ion a l a n d bot h New E n gla n d
          r egion a l r a t es.
June 27, 2006
    Examples of Key Findings:
•    Childhood and Adolescent Health
      – 96% aged 12 months to19 years have access to a PCP.
      – 12% of children are not treated properly for an URI and 18% are not tested
         properly for pharyngitis.
•    Comprehensive Diabetes Care
      – HbA1c testing is high at 92% but 20% tested have less-healthy results.
•    Women’s Health Care
      – Only 4% of pregnant women did not receive prenatal care in their first
      – 16% of NH women in high-risk age category are not being screened for
         breast cancer.
•    Mental Health & Substance Abuse
      – 75% of diagnosed depression patients, who were treated with an
         antidepressant, did not receive at least 3 follow-up visits with their health care
•    Hospital Utilization
      – In contrast to Inpatient use rates, NH ambulatory Outpatient visit rates/1,000
         enrollees were higher than all three benchmarks: national/NE/nNE.

    June 27, 2006
Appendix-level detail on HEDIS measure results:

• Data Tables will be available showing previously
  released HEDIS data for each of three
  HealthPlans, plus NCQA computed benchmarks
  for the Nation, New England and northern New

June 27, 2006
Sample of Appendix-level data:


                                                                                     New Hampshire
Adolescent Immunization                                                              HEALTH PLAN               GEOGRAPHIC BENCHMARKS

                                                                                                                          New       New
MEASURE                                                                     Anthem      CIGNA        Harvard   National   England   England
Adolescent Immunization Status (Hepatitis B)
Percentage of adolescents who had 3 doses of hepatitis B vaccine by their
13th birthday.                                                               73.2%       62.0%         76.2%    66.8%      80.6%       75.7%
Adolescent Immunization Status (MMR)
Percentage of adolescents who had a second dose of measles, mumps,
rubella vaccine by their 13th birthday.                                      93.1%       89.3%         97.0%    76.8%      92.1%       90.9%
Adolescent Immunization Status (VZV)
Percentage of adolescents who had one chicken pox vaccine by their 13th
birthday.                                                                    75.6%       57.7%         84.7%    55.8%      78.9%       68.2%
Adolescent Immunization Status (Combo 1)
Percentage of adolescents who had 2 doses of MMR and 3 doses of
Hepatitis B vaccine by their 13th birthday.                                  71.4%       61.3%         76.2%    63.0%      78.9%       73.4%

Adolescent Immunization Status (Combo 2)
Percentage of adolescents who had 2 doses of MMR, 3 doses of Hepatitis
B, and 1 dose of the chicken pox vaccines by their 13th birthday.            60.5%       43.3%         69.1%    46.9%      68.7%       57.0%

June 27, 2006