Feb. 23, 2026
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 2024 reflect rates on certain quality measures for members in our commercial HMO, PPO and marketplace HMO and Point of Service plans.
Refer to a summary of measures for reporting years 2022, 2023 and 2024 for more details.
Highlights from 2024 included:
Members in commercial HMO plans demonstrated improvement in:
- Controlling High Blood Pressure: 8.28 percentage point increase
- Breast Cancer Screening: 1.23 percentage point increase
- Colorectal Cancer Screening: 4.67 percentage point increase
- Hemoglobin A1c Control for Patients with Diabetes: 5.97 percentage point increase
Members in commercial PPO plans demonstrated improvement in:
- Controlling High Blood Pressure: 8.52 percentage point increase
- Breast Cancer Screening: 1.92 percentage point increase
- Hemoglobin A1c Control for Patients with Diabetes: 9.64 percentage point increase
Members in marketplace HMO plans demonstrated improvement in:
- Controlling High Blood Pressure: 6.10 percentage point increase
- Breast Cancer Screening: 0.47 percentage point increase
Marketplace POS plans entered their first measurement year with the following ratings:
- Controlling High Blood Pressure: 60.10%
- Breast Cancer Screening: 67.12%
- Colorectal Cancer Screening: 51.63%
Update on childhood immunizations measure: In measurement year 2024, we transitioned to Childhood Immunization Status – Combination 10 measure, from the CIS − Combination 3. The Combination 10 measure tracks children who had each of 10 vaccines given on or before their second birthday, rather than each of seven vaccines for the Combination 3 measure.
You play an important role in providing 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.
Our 2024 interventions impacting results included:
- Distributing 19,642 Fecal Immunochemical Test kits to marketplace members to encourage colorectal cancer screening
- Distributing customized information to members on controlling blood pressure
- 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 published newsletter articles, 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. You can access information on HEDIS measures in our Availity® Essentials payer space. Download the Quality Care booklet from the Resources section under Quality Improvement.
The Centers for Medicare & Medicaid Services’ Quality Rating System measures similar areas of care for members enrolled in marketplace health care plans.
HEDIS is a registered trademark of the National Committee for Quality Assurance.