Community Health Network of Connecticut, Inc.® (CHNCT) utilizes a comprehensive set of health measures to evaluate and assist the provider community with balancing both time and resources to improve patient experience, reduce unnecessary healthcare expenditures, and address population health concerns.
The American Academy of Pediatrics references three types of health measures:1
The health measures are derived from the following measure stewards and data sets:
1Terry Adirim, Kelley Meade, Kamila Mistry, COUNCIL ON QUALITY IMPROVEMENT AND PATIENT SAFETY, COMMITTEE ON PRACTICE AND AMBULATORY MANAGEMENT, Wayne H. Franklin, Terry Adirim, David Gordon Bundy, Laura Elizabeth Ferguson, Sean Patrick Gleeson, Michael Leu, Brigitta U. Mueller, Daniel Robert Neuspiel, Michael Lawrence Rinke, Richard N. Shiffman, Joel S. Tieder, Geoffrey R. Simon, Cynthia N. Baker, Graham Arthur Barden, Oscar “Skip” Wharton Brown, Jesse M. Hackell, Amy Peykoff Hardin, Kelley E. Meade, Scot Benton Moore, Julia Richerson; A New Era in Quality Measurement: The Development and Application of Quality Measures. Pediatrics January 2017; 139 (1): e20163442. 10.1542/peds.2016-3442
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
HEDIS® rates are the most widely used set of healthcare performance measures on important preventive and clinical services. As a result, HEDIS® is the most widely used evaluation tool to measure provider performance and quality of care.
Because HEDIS® measures are proprietary; details about the measures may only be accessed securely. To access the HEDIS® Quick Reference Guide and HEDIS® specific TIP Sheets, please log in to the secure provider portal.
HEDIS® TIP Sheets:*
* Please note: This is not a comprehensive list of all health measures. We have created a set of tip sheets based on measure performance to help practices improve their rates. For information on all HEDIS® Medicaid measures, refer to the HEDIS® Quick Reference Guide.
In addition to HEDIS® rates, CHNCT uses the CMS Core Set measures as well as other measures to evaluate and assist the provider community in balancing both time and resources to improve patient experience, address population health concerns, including social determinants of health (SDOH), and reduce unnecessary healthcare expenditures.
Below is a list of TIP Sheets & handouts:
HEDIS® stands for Healthcare Effectiveness Data and Information Set, and is a tool developed by the National Committee for Quality Assurance (NCQA) to measure health plan performance on important dimensions of care and service. HEDIS® is an annual project of data collection and assessment of defined performance measures; results are used to evaluate where to focus quality improvement efforts.
The Community Health Network of Connecticut, Inc.® (CHNCT) HEDIS® review consists of over fifty measures across the following domains of care:
Annual HEDIS® data is collected from Connecticut Medical Assistance Program (CMAP) providers by CHNCT which later undergoes a compliance audit conducted by an NCQA certified HEDIS® auditor. HEDIS® data affords a unique opportunity to assess the care provided to the entire Connecticut Medicaid and Children’s Health Insurance Program (CHIP) membership.
Medical records are reviewed for services performed in the previous calendar year; however, some measures may require additional periods of time, especially for exclusions.
For example, the measurement period for cervical cancer screening is within the previous three years for women ages 21-64 who had cervical cytology performed, or every five years for women ages 30-64 who had a cervical cytology/HPV co-testing performed. The specific periods of service for each member are included within the medical record request issued to practices by CHNCT.
The types of services reviewed are specific to each HEDIS® measure, but generally include:
Two examples of medical record requests based on member criteria are detailed below.
|Medical Record(s) Required
|Eye Exam for Patients with Diabetes (EED)
Hemoglobin A1c Control for Patients with Diabetes (HBD)
Blood Pressure Control for Patients with Diabetes (BPD)
|Retinal eye exam with an eye care professional
HbA1c test and result
Blood pressure reading
|Lead Screening in Children (LSC)
|Date of lead screening test with result/finding
CHNCT relies on the data collected from CMAP providers to comply with HEDIS®. In January of each year, randomly selected providers will receive a medical record review letter outlining the process, along with an instruction sheet. Medical record data collection will begin in February, and continue into May. The sooner that practices provide requested clinical information, the smoother the process will go.
If your practice is interested in setting up an arrangement by which CHNCT can access your Electronic Health Record (EHR) remotely to obtain records, please contact us at 1.866.317.3301.
Alternatively, your practice can send the requested records securely by fax to CHNCT’s dedicated fax line at 203.265.2945; via email to firstname.lastname@example.org; or via regular mail to:
Community Health Network of Connecticut, Inc.®
HEDIS® Data Collection
11 Fairfield Boulevard
Wallingford, CT 06492
If your practice stores medical records in a central location and would like CHNCT to address all requests for medical records to that location, please let us know right away. You can contact us by email at email@example.com or by phone at 1.866.317.3301 Monday - Friday, from 8:00 a.m. to 5:00 p.m.; a voicemail is available after hours.
HEDIS® data collection is performed annually, and is a collaborative effort between providers and health plans to monitor and compare health plan program performance as outlined in the measure specifications developed by NCQA. The result is a comprehensive assessment of healthcare delivery that is beneficial to both members and providers. The health measures encompass evidenced-based preventive health and disease management guidelines. CHNCT and DSS utilize the data obtained to identify quality improvement opportunities for the HUSKY Health program.
CHNCT clinical staff will review the submitted medical records
Yes, all CHNCT staff follow the Health Insurance Portability and Accountability Act (HIPAA) guidelines while collecting and reviewing member information.
Under the HIPAA privacy rule, data collection for HEDIS® is permitted and does not require patient consent or authorization. Our members’ personal health information is maintained in accordance with all federal and state laws. Data is reported collectively without individual identifiers. All of the providers’ records are protected by this law.
Some of the measures look for services that may have occurred prior to 2020. For example, Cervical Cancer Screening (CCS) may look back three to five years.
No, we ask that you only provide the minimum information necessary to meet our request.
Records may be faxed to 203.265.2945, 203.626.7009, or 203.626.7010. They may also be sent to our secure email at firstname.lastname@example.org, or mailed to Community Health Network of Connecticut, Inc.® at 11 Fairfield Blvd., Wallingford, CT 06492.
Content reproduced with permission from HEDIS 2023, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. Anyone desiring to use or reproduce the materials without modifications for a quality improvement non-commercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA.
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications.
This portion of the HUSKY Health website is managed by Community Health Network of Connecticut, Inc.®, the State of Connecticut’s Medical Administrative Services Organization (ASO) for the HUSKY Health program. For the general HUSKY Health website gateway, please visit portal.ct.gov/husky. HUSKY Health includes Medicaid and the Children’s Health Insurance Program, and is administered by the Connecticut Department of Social Services (DSS).