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.


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)

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

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

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

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.

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 HEDIS® TIP Sheets:

  • Avoidance of Antibiotic Treatment for Acute Bronchitis
  • Adult BMI Assessment
  • Antidepressant Medication Management
  • Asthma Medication Management
  • Breast Cancer Screening
  • Controlling Blood Pressure
  • Cervical Cancer Screening
  • Comprehensive Diabetes Care
  • Chlamydia Screening in Women
  • Appropriate Treatment for Children with Pharyngitis
  • Imaging Studies for Low Back Pain
  • 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.


HEDIS® Overview

What is HEDIS®?

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 CHNCT HEDIS® review consists of over 50 measures across the following domains of care:

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

Annual HEDIS® data is collected from Connecticut Medical Assistance Program (CMAP) providers by CHNCT 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:

  • Patient History
  • Lab results
  • Condition/medication list
  • Specialist consultations
  • Medical records for a specified period

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
Nephropathy evaluation/treatment
Lead Screening in Children (LSC) Date of lead screening test with result/finding

Questions & Answers

Q: What do CMAP providers need to do in support of the annual HEDIS® medical record review?

A: CHNCT relies on the data collected from CMAP providers to comply with HEDIS®. In February each year, randomly selected providers will receive a medical record review letter outlining the process along with an instruction sheet. Medical record data collection will begin in February and continue into May. The sooner that practices provide requested clinical information, the smoother the process will go.

If your practice is interested in setting up an arrangement by which CHNCT can access your Electronic Health Record remotely to obtain records, please contact us at 1.866.317.3301.

Alternatively, your practice can send the requested records by fax to CHNCT’s secure, dedicated fax line (203.265.2945); secure email to quality@chnct.org; or mail via the United States Postal Service. CHNCT can also obtain records on-site by request.

If your practice would like CHNCT to obtain medical records on-site or if your practice stores medical records in a central location and would like CHNCT to address all requests for medical records to that location, please let us know right away. You can contact us by email at quality@chnct.org or by phone at 1.866.317.3301 Monday - Friday from 8:00 a.m. to 5:00 p.m.; a voicemail is available after hours.


Q: How are the results of my practice’s health measures used?

A: 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.


Q: Who will review the medical records?

A: CHNCT clinical staff will review the submitted medical records.


Q: Will providers be asked to change or resubmit claims?

A: No.


Q: Will the member's personal health information be protected?

A: Yes, all CHNCT staff follow the Health Insurance Portability and Accountability Act (HIPAA) guidelines while collecting and reviewing member information.


Q: Who do I call if I have questions?

A: 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.

Disclaimer

Content reproduced with permission from HEDIS® 2019, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of NCQA. HEDIS® measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. Anyone desiring to use or reproduce the materials without modification for a quality improvement non-commercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the specifications. To purchase copies of this publication, including the full measures and specifications, contact NCQA Customer Support at 888-275-7585 or visit www.ncqa.org/publications.

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 for the HUSKY Health Program. For the general HUSKY website gateway, please visit www.ct.gov/husky. HUSKY Health includes Medicaid and the Children’s Health Insurance Program, and is administered by the Connecticut Department of Social Services.