NCQA and Chlamydia Screening Measurement
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NCQA and Chlamydia Screening Measurement

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Presented by Sepheen C. Byron, MHS, Director, Performance Measurement, NCQA, at the 2013 National Chlamydia Coalition meeting. ...

Presented by Sepheen C. Byron, MHS, Director, Performance Measurement, NCQA, at the 2013 National Chlamydia Coalition meeting.

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  • 1. NCQA and Chlamydia Screening Measurement Sepheen C. Byron, MHS Director, Performance Measurement
  • 2. Agenda• Brief overview of NCQA• HEDIS® and the Chlamydia Screening in Women Measure• Measures Development Process February 2013
  • 3. National Committee for Quality AssuranceMissionTo improve the quality of health care.VisionTo transform health care throughquality measurement, transparency, andaccountability. February 2013
  • 4. How NCQA Evaluates Quality• Accreditation Programs – Health Plans & Managed Behavioral Health Care Organizations – Accountable Care Organizations – Wellness & Health Promotion – Case Management & Disease Management• Certification Programs – Physician & Hospital Quality – Utilization Management & Credentialing February 2013
  • 5. How NCQA Evaluates Quality• Recognition Programs – Patient-Centered Medical Home – Diabetes, Heart/Stroke• Distinction Programs – Multicultural Health Care – Distinction in Patient Reporting• Report Cards February 2013
  • 6. Healthcare Effectiveness Data & Information Set: HEDIS®Over 80 measures across 5 domains• Effectiveness of Care – e.g. preventive care, clinical conditions• Access and Availability of Care – e.g. primary care, prenatal/postpartum care• Experience of Care – CAHPS Health Plan Survey for adults and children• Utilization and Relative Resource Use – e.g. readmissions, resource use for diabetics• Health Plan Description Information – e.g. race/ethnicity and language February 2013
  • 7. What Gets Measured Gets Improved February 2013
  • 8. Role of Performance Measures Clinical Performance Member Satisfaction (HEDIS) + (CAHPS) = 45.86% Health Plan = 54.14% (Accreditation Standards)NCQA Accreditation is the only program in the market to require health plans to report on clinical performance. February 2013
  • 9. 39 States Require Use of HEDIS/CAHPS WA VT ME MT ND MN NH OR ID SD WI NY MA MI RI WY CT PA IA NJ NV NE OH DE IL IN UT MD WV CA CO VA DC KS MO KY NC TN AZ OK NM AR SC MS AL GA TX LAAK FL HI Commercial (25) Medicaid (34) Both February 2013
  • 10. 34 State Medicaid Programs Require Use of HEDIS/CAHPS WA ME MT ND VT MN NH OR MA ID SD WI NY MI RI WY CT PA IA NJ NV NE OH DE IL IN UT MD WV CA CO VA DC KS MO KY NC TN AZ OK NM AR SC MS AL GA TX LAAK FL HI Medicaid (34) February 2013
  • 11. What Makes a Good Measure?Criterion DescriptionImportance Relevance to stakeholders, able to improve health outcomes in areas of poor performanceScientific Evidence for Strong evidence that draws on systematic reviews, showsthe Content of the relationship of outcomes to actions of the health care deliveryMeasure systemScientific Soundness Well defined, valid (credible) and reliable (repeatable)of the MeasureFeasibility Data are readily available and can be collected without undue burdenUnderstandability Key stakeholders can understand and use results for decision makingOther Factors as Health care disparities? HIT sensitivity?Relevant February 2013
  • 12. How We Get Feedback• Advisory Panel input throughout the process• Public Comment Period• Interactions with key stakeholders• Educational conferences February 2013
  • 13. Measures Development ProcessEnvironmental Scan, Evidence & Utilization of Finalize Guideline Draft Measure Public Measures by Field Testing Measure Review, Specifications Comment States, Plans, Prioritize Specifications & Providers Concept Areas Stakeholder Feedback February 2013
  • 14. Chlamydia Screening in Women• Percentage of women 16 to 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year• Features – Age stratification: 16 – 20 years, 21 – 24 years – Commercial and Medicaid Plans – Administrative data collection February 2013
  • 15. Identifying the Population• Identification of Sexual Activity – Pharmacy data • Women dispensed prescription contraceptives • Pregnancy test – Claim/encounter data • Codes for “sexual activity”• Exclusions – Pregnancy test followed by prescription for isotretinoin or x-ray February 2013
  • 16. Measure Performance100908070605040302010 0 2006 2007 2008 2009 2010 2011 Commercial HMO Commercial PPO Medicaid HMO February 2013