Health Measures

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.

Important

CHNCT utilizes all of these critical health measure types to ensure that barriers identified at the process, structural, or outcome level are addressed.

The American Academy of Pediatrics1 references three types of health measures:

  1. Structural measures assess “sufficiency of resources and proper system design” (e.g., access to primary or specialty care and use of electronic health records)
  2. Process measures assess “the way in which care and services are provided, including assessment, evaluation, diagnosis and treatment” (e.g., prescribing asthma controller medications, screenings and counseling)
  3. Outcome measures assess “the effect of care delivered on the patient’s (and family’s) health and function” (e.g., proportion of immunized patients, the number of emergency department visits due to asthma attacks or permanent disability/death)

1http://pediatrics.aappublications.org/content/139/1/e20163442

HEDIS® is a registered trademark of NCQA

The health measures are derived from the following measure stewards and data sets:

  • National Committee for Quality Assurance (NCQA®) – Healthcare Effectiveness Data and Information Set (HEDIS®)
  • Centers for Medicare and Medicaid Services (CMS) – Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set)
  • Centers for Medicare and Medicaid Services (CMS) – Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Custom health measures developed by the Connecticut Department of Social Services (DSS)

Health Measure Improvement – Learn how to improve your scores

HEDIS® Measures

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.

Below is a list of HEDIS® TIP Sheets:

  • Antidepressant Medication Management
  • Asthma Medication Ratio
  • Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis
  • Breast Cancer Screening
  • Cervical Cancer Screening
  • Diabetes Care Measures
  • Chlamydia Screening in Women
  • Controlling High Blood Pressure
  • Imaging Studies for Low Back Pain
  • Immunizations for Adolescents
  • Prenatal and Postpartum Care
  • Spirometry Testing for COPD
  • Weight Assessment and Counseling for Children/Adolescents

* 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.

CMS Core Set and Other Health Measures

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® Overview

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® MY 2020 review consists of over 50 measures across the following domains of care:

  • Access/Availability of Care
  • Effectiveness of Care
  • Health Plan Descriptive Information
  • Utilization and Risk Adjusted Utilization

Annual HEDIS® data is collected from Connecticut Medical Assistance Program (CMAP) providers by CHNCT for the hybrid measures, 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.

What dates of service are included in the annual review?

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.

What types of services and information in the medical record will be reviewed?

The types of services reviewed are specific to each HEDIS® measure, but generally include:

  • Condition/medication list
  • History
  • Lab results
  • Medical record notes for a specified period of time
  • Specialist consultations

Two examples of medical record requests based on member criteria are detailed below.

HEDIS® Measure Medical Record(s) Required
Comprehensive Diabetes Care (CDC) 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

Questions & Answers

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 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 3 to 5 years.

  1. If the patient is yours but has not received the service that is being asked, simply note that on the patient chart pull list as SNR – Service Not Received
  2. If the patient is not yours at all, you can note that as NMP – Not My Patient

No, we ask that you only provide the minimum 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 quality@chnct.org or mailed to Community Health Network of Connecticut, Inc.® at 11 Fairfield Blvd., Wallingford, CT 06492.

If you have any questions, please contact CHNCT directly at the phone or fax number included with the request you receive. You may also email our Quality Management Department at quality@chnct.org or call 1.866.317.3301 at any time.

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).