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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

Know Your HEDIS Facts

Date: 11/13/19

Know Your HEDIS Facts

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a set of performance measures developed by the National Committee for Quality Assurance (NCQA). The more than 90 HEDIS measures:

·         Examine the effectiveness, availability and experience of care and more.

·         Inform the 190 million people enrolled in health plans that report HEDIS results.

·         Are updated yearly. Go to the NCQA website at ncqa.org/hedis/measures for more details.

·         Are used to evaluate the plan’s performance on important aspects of care and service. California Health & Wellness Plan (CHWP) reviews HEDIS data to identify ways to improve performance and make sure members receive appropriate care.

·         Hold health plans accountable for timeliness and quality of health care services.

Review the measures below to make sure HEDIS standards are met. This helps to improve our HEDIS scores and members outcomes.

 

HEDIS Measure

Details

Breast Cancer Screening

This measure assesses women ages 50 to 74 who had at least one mammogram to screen for breast cancer in the past two years.

According to the Centers for Disease Control and Prevention (CDC), breast cancer is one of the most common cancers among women of all racial and ethnic backgrounds. Early detection during routine screenings beginning at age 50 (or 40 for women who have a higher risk) can reduce the risk of death.

Cervical Cancer Screening

This measure assesses either women ages 21 to 64 who had a cervical cytology (Pap test) performed every three years or those ages 30 to 64 who had cervical cytology and HPV co-testing every five years.

Cervical cancer was previously considered a leading cause of death in women. The availability of effective screening tests for early detection has reduced the risk of death by more than 50 percent over the past 30 years.

Chlamydia Screening in Women

This measure assesses women ages 16 to 24 who are sexually active and have been tested for Chlamydia at least once within the past year.

Chlamydia is one of the most common sexually transmitted infections for young people in the United States, according to the CDC. It is estimated that 1 in 20 sexually active women ages 14 to 24 are infected. Delays in treatment can lead to serious health problems, such as pelvic inflammatory disease and fertility issues.

Prenatal and Postpartum Care

This measure assesses two factors: the percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the health plan, and the percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.

Women with low-risk pregnancies should receive an examination at least once during the first trimester of the pregnancy and an exam within four to six weeks after delivery, according to the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.

Refer to the HEDIS QRG (under Quality Improvement (QI) program tab) for relevant codes to use for the measures above.

For more information about the HEDIS measures, go to www.ncqa.org.