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Quality of care and services provided
to members is an important measure of the effectiveness of any health
plan. The National Committee for Quality Assurance (NCQA), a not-for-profit
organization, measures health plan quality using a standardized series
of health plan quality measures called the Healthcare Effectiveness
Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare
Providers and Systems
(CAHPS®1).
Plans reporting HEDIS and CAHPS data
must adhere to stringent specifications on how to collect the data.
An independent auditor conducts an audit to ensure data collection specifications
are being followed. Plans meeting all audit specifications receive
a "Full Audit" designation. Once again, HNE has received this
honor for the HEDIS 2007 audit.
NCQA publishes HEDIS and CAHPS results
in Quality Compass®2, a national database of results
for managed care plans. HNE uses Quality Compass 2007®
90th percentile as a benchmark. As reported in the NCQA's
"State of Managed Care Quality 2007" report, Quality Compass
data represents over 241 health plans across the country.
HNE uses HEDIS/CAHPS results to help
evaluate our performance and implement improvements as needed. Where
our rate falls short of the benchmark, teams analyze data to identify
barriers that prevent members from receiving appropriate or timely care,
or that preclude providers from rendering appropriate or timely care.
Once barriers are identified, the information is used to develop educational
or behavioral interventions directed at members and/or providers. These
interventions encourage the medically appropriate use of available benefits
by members, and give providers tools they need to ensure members receive
suitable and timely care as well as age- and sex-appropriate preventive
care services.
If you have any questions or comments
regarding HEDIS/CAHPS rates, please contact Pat Scheer @ 413-233-3435.
1 CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)
2 Quality Compass® is a registered trademark of the National Committee for Quality Assurance (NCQA)
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