Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

December 2017

2017 Annual HEDIS® and QRS Reports

Blue Cross and Blue Shield of Texas (BCBSTX) has a quality improvement program (QIP) to better serve our members. The purpose of the QIP is to monitor and help improve the care and service our members receive from BCBSTX contracted providers. We focus on preventive health, safety and condition management. QIP helps meet the needs of the members in the Blue EssentialsSM HMO, Blue Advantage HMOSM and Blue Choice PPOSM Small Business Health Options Program (SHOP) health plans.

There is a standard way to measure important areas of care and service called Health Care Effectiveness Data and Information Set (HEDIS). These measures were developed by the National Committee for Quality Assurance and are widely used to measure health care performance in the U.S.

The Centers for Medicare & Medicaid Services has a similar set of measures called the Quality Rating System (QRS). These measure similar areas of care and are specifically for members enrolled in Marketplace health care plans.

Through the QIP, BCBSTX measures how we are doing against the goals we’ve set. The table below summarizes how we are doing on selected measures.

Care Provided to BCBSTX Members 2017 Quality Compass National Average HEDIS Rates:
Blue Essentials

HMO
QRS Rates:
Blue Advantage

HMO
QRS Rates:
Blue Choice PPO SHOP PPO
Prevention and Screening
Childhood Immunization
• Combination 3 Rate: 4 DTaP, 3 IPV,
 1 MMR, 3 HiB, 3 Hep B, 1 VZV, 4 PCV

73%

55%

73%

85%
Breast Cancer Screening 71% 61% 57% 67%
Cervical Cancer Screening 74% 67% 47% 66%
Colorectal Cancer Screening 60% 38% 38% 54%
Respiratory Conditions
Appropriate Testing for Children with Pharyngitis 84% 81% 72% 83%
Medication Management for People with Asthma
• Total Medication Compliance 75%


49%


43%


48%


60%
Comprehensive Diabetes Care
Comprehensive Diabetes Care
• Hemoglobin A1c (HbA1c) Testing
• HbA1c Control (<8.0%)
• Eye Exam (retinal or dilated exam)
• Medical Attention for Nephropathy

90%
51%
51%
89%

84%
28%
21%
88%

89%
48%
34%
89%

89%
42%
36%
87%
Overuse/Appropriateness
Appropriate Treatment for Children with Upper Respiratory Infection 88% 75% 76% 82%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 28% 22% 19% 7%
Medication Management  
Annual Monitoring for Patients on Persistent Medications – Total 83% 84.5% 86% 85%
Prenatal/Postpartum Care        
Prenatal and Postpartum Care
• Timeliness of Prenatal Care
• Postpartum Care

81%
70%

65%
32%

80%
66%

82%
56%