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As part of Independence's annual review process, we obtain data from the
Healthcare Effectiveness Data and Information Set (HEDIS®)
Quality Compass® of hospital discharges and frequency rates of
selected cardiac procedures to help evaluate utilization for our Keystone
Health Plan East (KHPE) HMO and Personal Choice® PPO commercial
and Keystone 65 HMO and Personal Choice 65SM PPO Medicare Advantage
members. The results showed that utilization remains within national and
regional standards for most indicators.
HEDIS® rates must score between the 10th and 90th national
percentiles, as published by NCQA's Quality Compass, to be considered as
meeting the goal. Because utilization is typically higher in this part of the
country, as compared to the rest of the United States, the Plan may include the
10th and 90th Mid-Atlantic Regional percentiles as thresholds for appropriate
utilization when calculating its score.
Hospital utilization
Hospital utilization comparison of acute discharges per 1,000 shows that the
overall HMO and PPO rates remain within the relevant national or regional 10th
and 90th percentiles as the appropriate thresholds for over/under utilization.
Comparison of HEDIS® rates for KHPE HMO, Keystone 65 HMO, and
Personal Choice 65 PPO showed a decreased hospital utilization rate between
2014 and 2015, and Personal Choice PPO showed an increase from 2014 to 2015.
Members enrolled in Medicare Advantage programs show a higher rate of change
than previous years.
Use of services
Independence also measured the frequency of selected procedure rates for
cardiac angioplasty, cardiac catheterization, and coronary artery bypass graft
(CABG) according to age and gender. Based on a comparison of 2015
HEDIS® utilization rates with respect to established thresholds,
utilization for use of services for these identified indicators were within the
established threshold for most age/gender categories.
There were two indicators that were above national and regional thresholds:
cardiac catheterization and angioplasty in males younger than age 65 who were
enrolled in Personal Choice 65 PPO. Rates are measured according to age group
and gender, and Independence recognizes the probability of unequal variance as
an issue with the cardiac procedure rates.
For more information
To learn more about HEDIS®, visit our website to view Highlighting HEDIS® articles
that have been published in Partners in Health Update. These articles
are educational resources for understanding HEDIS® measures. If
you have feedback about the Highlighting HEDIS® series or topic
requests, please email
us.
HEDIS is a registered trademark of the National Committee
for Quality Assurance (NCQA). Used with permission.
Quality
Compass® is a registered trademark of the National Committee for
Quality Assurance (NCQA).
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