Skip to main content

Quality

The Quality Improvement Program includes initiatives to ensure that members are receiving age-appropriate preventive health screenings and interventions to optimize health.

The information on this page provides useful information and tools for managing patient care based on industry-standard clinical practice guidelines.

    Preventive Depression Screening Program

    This program promotes collaboration, continuity and coordination between medical and behavioral health care.

    2019 HEDIS Toolkit

    HEDIS® (Healthcare Effectiveness Data and Information Set)

    2019 HEDIS® AT-A-GLANCE: KEY ADULT MEASURES

    Coordination of Care requires proactively identifying the patient’s needs, organizing care and communicating vital information at the right time to the right people.

    HEDIS® Guide Adult Quick Tips

    HEDIS® Adult Resource Guide

    This form is to assess care needs for older adults.

    Every year CMS or NCQA may ask your patient the following questions. How do you rate?

    The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

    We’re asking our providers to make sure to use accurate CPT Category II codes to improve efficiencies in closing patient care gaps and in data collection for performance measurement.

    Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

    This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

    2018 HEDIS Toolkit

    HEDIS® ensures health plans are offering quality preventive care and service to members. It also allows for a true comparison of the performance of health plans by consumers and employers.

    2018 HEDIS At-A-Glance Key Adult Measures

    This document details the importance of coordination of care.

    HEDIS Guide Adult Quick Tips

    Important information for Medicare providers.

    This form is to assess care needs for older adults.

    Every year CMS or NCQA may ask your patient the following questions. How do you rate?

    The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

    Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

    A HEDIS quick reference guide for Pediatric care

    HEDIS reference guide for Pediatric care.

    This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

    2018 HEDIS At a Glance Key Pediatric Measures

    contact-us

    Need help? We're here for you.

    Contact Us
    Last Updated On: 8/6/2018