Feb. 25, 2025
As part of our Quality Improvement Program, we track services our members receive through Healthcare Effectiveness Data and Information Set (HEDIS®) measures and the Centers for Medicare & Medicaid Services’ Quality Rating System. New data from reporting year 2023 reflect rates on certain quality measures for members in our commercial HMO, PPO and marketplace HMO plans.
Refer to a summary of measures for reporting years 2021, 2022 and 2023 for more details.
Highlights from 2023 included:
Members in commercial HMO plans demonstrated improvement in:
- Childhood Immunization, Combination 3: 0.48 percentage point increase, surpassing the national Quality Compass® average by 2.68 percentage points
- Breast Cancer Screening: 1.60 percentage point increase
- Colorectal Cancer Screening: 3.41 percentage point increase
- Hemoglobin A1c Control for Patients with Diabetes: 5.11 percentage point increase
Members in commercial PPO plans demonstrated improvement in:
- Controlling High Blood Pressure: 3.65 percentage point increase
- Childhood Immunization, Combination 3: 3.99 percentage point increase
- Breast Cancer Screening: 2.02 percentage point increase
- Colorectal Cancer Screening: 10 percentage point increase
- Hemoglobin A1c Control for Patients with Diabetes: 3.65 percentage point increase
Members in marketplace HMO plans demonstrated improvement in:
- Controlling High Blood Pressure: 8.52 percentage point increase
- Breast Cancer Screening: 1.59 percentage point increase
- Hemoglobin A1c Control for Patients with Diabetes: 1.46 percentage point increase
You play an important role in quality care. In addition to providing needed services, you may help identify care gaps, such as preventive screenings and chronic care management our members may need. We provide our members information on screenings and preventive care that you can discuss with them. Refer to our tip sheets for more information on HEDIS measures and closing care gaps.
Our 2023 interventions impacting results included:
- Distributing 16,505 Fecal Immunochemical Test kits to marketplace members to encourage colorectal cancer screening
- Continuing advancements in technology for collecting and reporting standard electronic clinical data for HEDIS and QRS measures
- Encouraging members to complete breast cancer screenings through direct calls and custom mailers, which included details on two convenient, cost-effective in-network mammography screening centers. We offered help with scheduling as needed.
About the measures: HEDIS® measures were developed by the National Committee for Quality Assurance. They’re widely used to measure health care performance in the U.S. See HEDIS Measures and Technical Resources for more details.
The Centers for Medicare & Medicaid Services’ Quality Rating System measures similar areas of care for members enrolled in marketplace health care plans.
Quality Compass and HEDIS are registered trademarks of NCQA.