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

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 Assurance
Mission
To improve the quality of health care.
Vision
To transform health care through
quality measurement, transparency, and
accountability.
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
LA
AK
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
LA
AK
FL
HI
Medicaid (34)
February 2013

11. What Makes a Good Measure?
Criterion Description
Importance Relevance to stakeholders, able to improve health outcomes in
areas of poor performance
Scientific Evidence for Strong evidence that draws on systematic reviews, shows
the Content of the relationship of outcomes to actions of the health care delivery
Measure system
Scientific Soundness Well defined, valid (credible) and reliable (repeatable)
of the Measure
Feasibility Data are readily available and can be collected without undue
burden
Understandability Key stakeholders can understand and use results for decision
making
Other 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 Process
Environmental
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 Performance
100
90
80
70
60
50
40
30
20
10
0
2006 2007 2008 2009 2010 2011
Commercial HMO Commercial PPO Medicaid HMO
February 2013