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% |
Results are rounded to the nearest percentage.
HEDIS is a registered trademark of NCQA