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Network Health

Healthcare Effectiveness Data and Information Set (HEDIS)

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HEDIS is a set of standardized performance measures the National Committee for Quality Assurance (NCQA) developed to allow for comparison across health plans based on quality, not just cost.

Your HEDIS scores can also help you understand how you compare to other Network Health providers, as well as to the national average. By working together, we can ensure your Network Health patients, our members, receive optimal preventive and quality care.

The HEDIS measures we collect change annually. Call us at 888-257-1985 if you have questions or want more information about other HEDIS measures

Preventive health care

Frequency of ongoing
prenatal care

Received at least 81% of expected prenatal visits

Timeliness of prenatal care

Received a prenatal care visit during first trimester or within
42 days of Network Health enrollment  

Timeliness of postpartum care

Received a postpartum visit 21 to 56 days after delivery 

Childhood immunizations
Ages: 0 – 2 years old

Received the following immunizations by second birthday:

  • One chicken pox (VZV) 
  • One measles, mumps, and rubella (MMR) 
  • One hepatitis A (HepA) 
  • Two influenza (flu) vaccines 
  • Two or three rotavirus (RV) 
  • Three H influenza type B (HiB) 
  • Three hepatitis B (HepB) 
  • Three polio (IPV) 
  • Four diptheria, tetanus, and acellular pertussis (DTaP) 
  • Four pneumococcal conjugate (PCV) 

Lead screening in children
Ages: 0 – 2 years old

Received one or more capillary or venous lead blood tests for lead poisoning by second birthday

Well-child visits
Ages: 0 – 15 months old

Received at least six well-child visits with PCP within first
15 months of life

Well-child visits
Ages: 3 – 6 years old

Received one or more annual well-child visits with PCP

Adolescent well visits
Ages: 12 – 21 years old

Received at least one annual comprehensive well visit with PCP or OB/GYN

Adolescent immunizations

Received the following immunizations by 13th birthday:

  • One meningococcal
  • One tetanus, diptheria toxoids, and acellular pertussis (Tdap)

Or:

  • One tetanus, diptheria toxoids (Td)

HPV vaccine

Received three doses of the human papillomavirus (HPV) vaccine by 13th birthday

Cervical cancer screening(s)
Ages: 21 – 64 years old

Received one or more Pap tests in 2010, 2011, or 2012

Weight counseling for nutrition and physical activity
Ages: 3 – 17 years old

Received an outpatient visit with a PCP or OB/GYN and had evidence of the following during the measurement year:

  • Body mass index (BMI) percentile documentation*
  • Counseling for nutrition
  • Counseling for physical activity

*Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.

BMI assessment
Ages: 18 – 74 years old

Received an outpatient visit and BMI was documented in 2011 or 2012

Condition-specific care

Cholesterol management 
For Network Health patients with cardiovascular conditions
Ages: 18 – 75 years old

Received:

  •  LDL-C screening  
  •  LDL-C control (< 100 mg/dl)*

*Must report most-recent values

Comprehensive diabetes care
For Network Health patients with Type 1 or Type 2 diabetes
Ages: 18 – 75 years old

Received:

  • HbA1c tests and values*
  • Dilated or retinal eye exam for diabetic retinal disease 
  • LDL-C tests and values*  
  • Nephropathy screening 
  • Blood pressure (BP) control monitoring*

*Must report most-recent values

High blood pressure control 
Ages: 18 – 85 years old

Received hypertension (HTN) diagnosis by June 30, 2012, and had a recorded BP*

*Must report most-recent values

Please note: Measurement year is January 1, 2012 to December 31, 2012, unless otherwise indicated.

 

 

 


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