Posted Dec. 18, 2020
Blue Cross and Blue Shield of Illinois (BCBSIL) collects Healthcare Effectiveness Data and Information Set (HEDIS) data from our providers to measure and improve the quality of care and services our members receive. HEDIS is a set of standardized performance measures developed and updated annually by the National Committee for Quality Assurance (NCQA) which allows comparison across health plans.
Each year, BCBSIL reports audited HEDIS results for Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM. These results are sent to the Illinois Department of Healthcare and Family Services (HFS), Centers for Medicare & Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA).
HEDIS rates are reported based on the previous year’s performance. BCBSIL uses HEDIS results to measure performance, pinpoint quality initiatives, and deliver educational programs for members and providers. The current HEDIS measures support many areas, including prevention and screening, diabetes and other chronic condition management, behavioral health, medication management, and availability and utilization of care.
For current year (CY) 2019/HEDIS 2020, BCCHP and MMAI hybrid measures were impacted by the COVID-19 pandemic. As a result, BCBSIL’s ability to collect medical record data was disrupted. Health plans will still be seeing the impact of the pandemic into CY 2020/HEDIS 2021.
Of the 26 HEDIS rates for BCCHP that were comparable to goals, eight (8) rates met NCQA Quality Compass® National goals. Seven (7) rates showed statistically significant improvements from the previous year. The Utilization HEDIS measures and first year measures were not included in the comparison.
View the 2020 BCCHP HEDIS results
Of the 35 HEDIS rates for MMAI that were comparable to goals, fifteen (15) rates met either national standards or State/CMS goals, while ten (10) rates demonstrated statistically significant improvements from the previous year. Utilization HEDIS measures and first year measures were not included in the comparison.
View the 2020 MMAI HEDIS results
For BCCHP, the measures continue to remain a focus in for 2020 are:
- Breast Cancer Screening
- Cervical Cancer Screening
- Controlling Blood Pressure
- Adult Access to Preventive/Ambulatory Health Services
- Comprehensive Diabetes Care — Dilated Eye Exam
- Antidepressant Medication Management (medication compliance rate for 84 days and 180 days)
- Follow up after Hospitalization for Mental Illness (7-day and 30-day follow-up rates).
In addition, the following measures will be included:
- Statin Therapy for Patients with Diabetes – 80% Adherence
- Initiation and Engagement of alcohol or other drug (AOD) Dependence Treatment — Engagement of Treatment
- Weight Assessment and Counseling for Nutrition and Physical Activity
- Childhood Immunizations
- Comprehensive Diabetes Care — A1c Test
For MMAI, the measures for 2020 are:
- Breast Cancer Screening
- Care for Older Adult (all four rates)
- Transitions of Care
- Comprehensive Diabetes Care — HbA1c Poor Control (>9%)
- Initiation and Engagement of AOD Abuse or Dependence Treatment (both rates)
- Antidepressant Medication Management (medication compliance rate for 84 days and 180 days)
- Follow up after Hospitalization for Mental Illness (7-day and 30-day follow-up rates)
In addition to the measures above the following measures will also be included:
- Controlling Blood Pressure
- Transition of Care
- Statin Therapy for Patients with Cardiovascular Disease — 80% Adherence
- Statin Therapy for Patients with Diabetes — 80% Adherence
- Adult Access to Preventive/Ambulatory Health Services
HEDIS is a registered trademark of NCQA
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.