HEDIS® and CAHPS® Reports
Blue Cross and Blue Shield of Illinois (BCBSIL) reports audited HEDIS® results – Health Care Effectiveness Data and Information Set. HEDIS is a nationally standardized set of measures related to important areas of care and service. Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health care performance measures in the United States.
HMO
Each year, Blue Cross and Blue Shield of Illinois reports audited Health Care Effectiveness Data and Information Set (HEDIS) results for HMO Illinois and BlueAdvantageSM HMO. HEDIS is a nationally standardized set of measures related to important areas of care and service. Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health care performance measures in the United States.
The 2012 BCBSIL HMO HEDIS Report, which is based on 2011 data using HEDIS 2012 specifications, includes measures across domains of care that reflect effectiveness of care, access/availability of care and utilization. Audited HEDIS results are reported for HMO Illinois and BlueAdvantage HMO combined. Overall, the HMOs exceeded the national average for 25 HEDIS indicators.
The following HMO HEDIS measures were at least five percentage points above the National Quality Compass rates:
- Prevention and Screening: Adult BMI, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (BMI Percentile, Counseling for Nutrition, Counseling for Physical Activity)
- Diabetes Care: Retinal Eye Exam
- Respiratory Conditions: Pharmacotherapy Management of COPD Exacerbation (Bronchodilator)
- Behavioral Health: Follow Up After Hospitalization for Mental Illness (7 day)
- Access/Availability of Care: Initiation and Engagement of Alcohol & Other Drug Dependence Treatment – Initiation of Treatment
The following HMO HEDIS measures were at least five percentage points below the National Quality Compass and demonstrated opportunities for improvement:
- Prevention and Screening: Immunizations for Adolescents; Chlamydia Screening in Women (Total)
- Respiratory Conditions: Appropriate Testing for Children With Pharyngitis, Appropriate Treatment for Children With Upper Respiratory Infection, Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis, Use of Spirometry Testing in the Assessment and Diagnosis of COPD
- Access/Availability of Care: Children’s and Adolescents’ Access to Primary Care Practitioners
- Utilization: Well-Child Visits in the First 15 Months of Life (6+ visits), Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life, Adolescent Well-Care Visits
View the 2012 HMO HEDIS results 
PPO
The 2011 BCBSIL PPO HEDIS results have been audited. They are based on 2010 data using HEDIS 2011 specifications, and include members residing in Illinois.
CAHPS® Results Show Member Satisfaction
As part of HEDIS, a survey is sent to a random sample of HMO members. Results of how members feel about their experience with care and service are reported in the CAHPS® – Consumer Assessment of Healthcare Providers and Systems – Report. The 2011 CAHPS® results are based on care provided in 2010. The following observations were noted:
- Member satisfaction with the HMOs of BCBSIL trended upward this year and when combining the 3 most favorable responses (8, 9, and 10 on a 0-10 scale) scored significantly higher than national averages.
- No significant changes in HMO scores from 2010 to 2011.
- BCBSIL HMOs rank at or above the 75th percentile of national benchmarks on 7 of 9 key composite measures.
To learn more about the HMO Illinois and BlueAdvantage HMO Quality Improvement (QI) program, including goals, processes and outcomes related to member care and service, view the QI Executive Summary or call 312-653-3465 to request additional information about the QI program.
