HEDIS Evaluation

Louisiana Healthcare Connections is committed to maintaining the necessary data for accurately assessing and comparing our plan’s performance against adopted HEDIS measures. A cross section of key staff from multiple departments serve on our HEDIS Steering Committee in order to provide strategic recommendations and dedicated oversight of the implementation of interventions designed to ensure state benchmarks are met.

The Louisiana Department of Health (LDH) identified more than 30 HEDIS measures to calculate annually. From those measures, LDH selected eight HEDIS and incentive measures for Louisiana Healthcare Connections to focus on. These focus HEDIS measures include:

• Postpartum Care - The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.
  • Numerator:
    • Complete PPC Visit
    • Cervical cytology
    • Providers may be asked to submit supplemental data (medical records) as some codes for PPC are bundled with the  delivery codes. 
  • Denominator: Woman who delivered a live birth on or between 10/8/2019 through 10/7/2020

• Well-Child Visits in the First 30 Months of Life (W30) – The percentage of members who had the following number of well-child visits with a PCP during the last 15 months.  Revised the measure name to Well-Child Visits in the First 30 Months of Life (formally the W15 Measure)

The following rates are reported.

1. Well-Child Visits in the First 15 Months.  Children who turned 15 months old during the measurement year. Six or more well-child visits.
2. Well-Child Visits for age 15 Months-30 Months. Children who turned 30 months of age during the measurement year. Two or more well-child visits
   • Numerator: Rate 1: six or more well-child visits on or before the 15 month birthday
   • Numerator: Rate 2: Two or more well-child visits between the child’s 15-month birthday and 30-month birthday
   • Denominator: Rate 1: Calculate the 15-month birthday as the first birthday plus 91 days
   • Denominator: Rate 2:  Date of second birthday plus 180 days

To avoid double counting events when only assessing administrative data or when combining administrative and medical record data, all events must be at least 14 days apart

• Child and Adolescent Well-Care Visits (WCV)- The percentage of enrolled members 3-21 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN practitioner during the measurement year.
• This measure is a combination measure that replaces the former “Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life” and “Adolescent Well-Care Visits” HEDIS measures.
• Added members age 7–11 years.
  • Numerator: At least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year
  • Denominator: Members 3– 21 years of age as of December 31, the measurement year.

• Follow-up Care for Children Prescribed ADHD Medication Initiation Phase - The percentage of children 6-12 who were newly prescribed ADHD medication who had a follow-up care visit within 30 days of when the medicine was dispensed.
  • Numerator: Initiation Phase – Member should receive an outpatient or follow up visit with a practitioner with prescribing authority, within 30 days after the date the medication was prescribed.
  • Denominator: Initiation Phase – Members 6-12 who were newly prescribed a ADHD medication between March 1st through February 28th of the Measurement Year.

• Follow-up Care for Children Prescribed ADHD Medication Continuation & Maintenance Phase - The percentage of children 6-12 who were newly prescribed ADHD medication who had TWO follow-up care visits within 300 days after the date the medication was dispensed.
  • Numerator: Continuation and Maintenance Phase – Member should receive TWO outpatient or follow up visits with a practitioner with prescribing authority within 31-300 days (9 months) after the Initiation Phase.
  • Denominator: Initiation Phase – Members 6-12 who were newly prescribed a ADHD medication between March 1st of the Prior Year through February 28th of the Measurement Year.

• Initiation of Injectable Progesterone Therapy in Woman with Previous Pre-term Births - The percentage of women 15-45 years of age with evidence of a previous pre-term singleton birth event (<37 weeks completed gestation) who received one or more progesterone injections between the 16th and 24th week of gestation.
  • Numerator: Women who had at least one progesterone injection between the 16th and 24th week of pregnancy.
  • Denominator: Women who had at least one progesterone injection between the 16th and 24th week of pregnancy.

• Controlling High Blood Pressure: the percentage of members ages 18-85 years of age who had a diagnosis of hypertension (HTN) and whose Blood Pressure (BP) was adequately controlled (>140/90) during the measurement year. 
  The most recent BP reading during the measurement year; if multiple BPreadings occur on the same date, use the lowest systolic and lowest diastolic BP reading.
  • Numerator: Members who have the most recent BP reading of <140/90 during the measurement year
  • Denominator:  Members who had at least two visits with diagnosis of hypertension during the measurement year or between January 1^st of the year prior to the measurement year and June 30^th of the measurement year

• Comprehensive Diabetes Care- The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following:
• Hemoglobin A1c (HbA1c) testing
• Eye exam (retinal) performed
• Kidney Health Evaluation
• Medical attention for nephropathy**

Numerators:**Medicare only

• Numerators:
  • HbA1C Testing: An HbA1C test performed during the measurement year
  • Medical Attention for Nephropathy** (Medicare line of business only): A nephropathy screening or evidence of nephropathy during the measurement year
  • Eye Exam: Screening or monitoring for diabetic retinal disease
  • Kidney Health Evaluation: Kidney health evaluation during the measurement year defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-cratinine ratio (uACR).             

• Denominator: Members ages 18-75 with diagnosis of Diabetes type 1 and type 2)

Benchmarks

The list below shows each HEDIS and incentive measure and the corresponding state benchmarks:

• Postpartum Care – (PPC): 83.21%
• Adolescent Well Care – (AWC): 54.57%
• Initiation for Children Prescribed ADHD Medicine – (IP): 45.00%
• Continuation and Maintenance for Children Prescribed ADHD Medicine – (C&M): 57.09%
• HIV Viral Load Suppression: 54.34%
• Initiation of Injectable Progesterone Therapy in Woman with Previous Pre-term Births – (PTB): 24.08%
• Comprehensive Diabetes Care (CDC) HbA1c Testing- 87.83%
• Comprehensive Diabetes Care (CDC) Eye exam: 57.89%
• Comprehensive Diabetes Care (CDC) Attention for Nephropathy: 90.51%
• Well-Child Visits (W34) Ages 3 to 6 - 73.89%
• Well-Child Visits (W15) 15 Months of life – 66.23%
• Controlling High Blood Pressure (CBP) – 58.64%

Intervention Strategies

The following intervention strategies were developed and implemented to meet state standards.

Member-Focused Efforts:

• HEDIS Health Check Coordinators  conduct outreach for the primary focus of helping members see their Primary Care Provider (PCP), schedule appointments and arrange transportation if necessary.
• Offered gift card incentives to members who attended specific appointments.
• Hosted health fairs and offered providers incentives to hold health fairs at their clinics on weekends.
• Utillized programs for sending immunization reminders to adolescent well-care and well-child members.
• Mailed monthly birthday cards and screening reminders to all adolescent well-care and well-child members.
• Care Gap Education
• Care Manager outreach including member assessment and case management
• Educated members and providers about My Health Pays and the healthy behaviors that earn rewards.

Provider-Focused Efforts:

• Provided practices with performance score cards and a list of non-compliant members.
• Reviewed denied claims for Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and worked with Provider Relations to resolve issues.
• Partnered with provider groups to assist with scheduling member appointments.
• Educated providers on coding and billing.
• Care gap education
• Distributed information to providers about our PMPM/Pay for Performance program.
• Included information on HEDIS and incentive measures in provider newsletters.
• Developed a process for collecting non-standard supplemental data to increase compliance rate on postpartum care. NOTE: Louisiana Healthcare Connections is continuing its efforts to collect supplemental data for the postpartum care measure by retrieving medical records from providers who used incorrect billing codes or failed to submit claims for postpartum care in 2019.

In addition to intervention initiatives, Louisiana Healthcare Connections identified the following challenges to address in promoting future improvements.

Member Challenges:

• Consistently missed appointments despite phone call reminders
• Missed screening deadlines
• Reluctance to discuss screening results
• Proximity of Primary Care Provider (PCP) assignment to members’ homes
• Refusal of assistance with appointment scheduling

Provider Challenges:

• Complications with billing and coding for services performed
• Ability to accommodate all appointments
• Awareness of member panel capacity
• Seeing patients after-hours
• Accepting appointment scheduling assistance

Louisiana Healthcare Connections will use all data to help improve the performance of our plan and to support our network providers in achieving our goal of providing excellent care to our members. Louisiana Healthcare Connections will refine and analyze these measures in 2016 for ongoing progress.

2019 HEDIS Outcomes

Louisiana Healthcare Connections uses HEDIS data to identify areas for improvement and monitor ongoing initiatives. Below are the 2019 results of the state-selected measures.

Postpartum Program Overview

The purpose of postpartum care is to maintain the health of a pregnant woman and her baby by providing necessary screenings and care between 7 and 84 days after delivery. A complete postpartum care visit should include:

• An OB/GYN appointment between 7 and 84 days after delivery AND any of the following:
• Pelvic Exam
• Breast and Abdomen Exam with Vital Signs
• Pap smear

Louisiana Healthcare Connections requests supplemental data to retrieve postpartum care records from provider offices. This helps ensure our members are getting the necessary screenings. Providers who complete postpartum visits and provide appropriate documentation as listed above receive a $50 incentive per postpartum visit.