NCQA and Chlamydia Screening Measurement

Sepheen C. Byron, MHSDirector, Performance Measurement

February 2013

Agenda

• Brief overview of NCQA• HEDIS® and the Chlamydia Screening in

Women Measure• Measures Development Process

February 2013

National Committee for Quality Assurance

MissionTo improve the quality of health care.

VisionTo transform health care throughquality measurement, transparency, and accountability.

February 2013

How NCQA Evaluates Quality• Accreditation Programs

– Health Plans & Managed Behavioral Health Care Organizations

– Accountable Care Organizations– Wellness & Health Promotion– Case Management & Disease Management

• Certification Programs– Physician & Hospital Quality– Utilization Management & Credentialing

February 2013

How NCQA Evaluates Quality

• Recognition Programs– Patient-Centered Medical Home– Diabetes, Heart/Stroke

• Distinction Programs– Multicultural Health Care– Distinction in Patient Reporting

• Report Cards

February 2013

Healthcare Effectiveness Data &Information Set: HEDIS®

Over 80 measures across 5 domains• Effectiveness of Care

– e.g. preventive care, clinical conditions• Access and Availability of Care

– e.g. primary care, prenatal/postpartum care• Experience of Care

– CAHPS Health Plan Survey for adults and children• Utilization and Relative Resource Use

– e.g. readmissions, resource use for diabetics• Health Plan Description Information

– e.g. race/ethnicity and language

February 2013

What Gets Measured Gets Improved

February 2013

Role of Performance Measures

Clinical Performance(HEDIS)

Member Satisfaction(CAHPS)+ = 45.86%

Health Plan(Accreditation Standards)

= 54.14%

NCQA Accreditation is the only program in the market to require health plans to report on clinical performance.

February 2013

39 States Require Use of HEDIS/CAHPS

Commercial (25)

DC

RI

WA

OR

CA

NV

WI

NM

TX

NE

MN

AR

FL

CO

IA

NC

MI

PA

ME

NY

VT

IN

CT

NJ

MD

VA

MA

MO

HI

UTOH

AZ

KS

OK

GA

SC

TN

MT

KY

WV

LA

MS AL

IL

SD

ND

ID

WY

AK

NH

Medicaid (34)

Both

DE

February 2013

34 State Medicaid Programs Require Use of HEDIS/CAHPS

DC

RI

WA

OR

CA

NV

WI

NM

TX

NE

MN

AR

FL

CO

IA

NC

MI

PA

ME

NY

VT

IN

CT

NJ

MD

VA

MA

MO

HI

UTOH

AZ

KS

OK

GA

SC

TN

MT

KY

WV

LA

MS AL

IL

SD

ND

ID

WY

AK

NH

Medicaid (34)

DE

February 2013

What Makes a Good Measure?Criterion Description

Importance Relevance to stakeholders, able to improve health outcomes in areas of poor performance

Scientific Evidence for the Content of the Measure

Strong evidence that draws on systematic reviews, shows relationship of outcomes to actions of the health care delivery system

Scientific Soundness of the Measure

Well defined, valid (credible) and reliable (repeatable)

Feasibility Data are readily available and can be collected without undue burden

Understandability Key stakeholders can understand and use results for decision making

Other Factors as Relevant

Health care disparities? HIT sensitivity?

February 2013

How We Get Feedback

• Advisory Panel input throughout the process

• Public Comment Period• Interactions with key stakeholders• Educational conferences

February 2013

Environmental Scan,

Evidence & Guideline Review,

Prioritize Concept Areas

Draft Measure

Specifications

Field Testing

Public Comment

Finalize Measure

Specifications

Utilization of

Measures by States, Plans, &

Providers

Stakeholder Feedback

Measures Development Process

February 2013

Chlamydia Screening in Women

• Percentage of women 16 to 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year

• Features– Age stratification: 16 – 20 years, 21 – 24

years– Commercial and Medicaid Plans– Administrative data collection

February 2013

Identifying the Population

• Identification of Sexual Activity– Pharmacy data

• Women dispensed prescription contraceptives• Pregnancy test

– Claim/encounter data• Codes for “sexual activity”

• Exclusions– Pregnancy test followed by prescription for

isotretinoin or x-ray

February 2013

Measure Performance

2006 2007 2008 2009 2010 20110

10

20

30

40

50

60

70

80

90

100

Commercial HMO Commercial PPO Medicaid HMO