HEDIS-Based Clinical Measure DescriptionsThe Alliance’s Quality Based Incentives (QBI) Program provides an opportunity for all physicians to benefit by rewarding high quality care and effective systems of care. QBI clinical criteria are based on Health Plan Effectiveness Data and Information Set (HEDIS) measures. A brief description of each measure follows below, highlighting eligibility and compliance criteria. Physician performance is assessed based on claims and encounter data. Contact the Quality Improvement Manager at 831-430-5564 for more detailed information. |
QBI MatricesThe document links below provide more detailed information about Incentives for |
Well-Child Visits in the First 15 Months of Life
Description: The percentage of members who turned 15 months of age during the measurement year, who were continuously enrolled in the plan from 31 days – 15 months of age, and who received five or more well-child visits with a primary care practitioner by age 15 months.
Well-Care Visits 3-6 Years
Description: The percentage of members who were three, four, five, or six years old during the measurement year, who were continuously enrolled during measurement year, and who received a well-child visit with a primary care provider.
Adolescent Well-Care Visits
Description: The percentage of members who were age 12-21 during the measurement year, who were continuously enrolled during the measurement year, and who had a comprehensive well-care visit with a primary care provider or an OB/GYN provider.
Appropriate Use of Medications for Asthma, Age 5-9, 10-17, 18-56, and 5-56 Years
Description: The percentage of members 5-56 (also broken down 5-9, 10-17, and 18-56) who were identified with persistent asthma, and who were prescribed medications acceptable as primary therapy for long-term control of asthma (controller medication).
Breast Cancer Screening
Description: The percentage of women 50-69 who were continuously enrolled during the measurement year and the year prior to the measurement year, and who had a mammogram during the measurement year or the year prior to the measurement year.
Cervical Cancer Screening
Description: The percentage of women age 21 through 64 years who were continuously enrolled during the measurement year and who received one or more cervical cancer screening tests (i.e., Pap smears) during the measurement year or the two years prior to the measurement year.
Comprehensive Diabetes Care (LDL-C Screening)
Description: The percentage of members with diabetes (Type I or Type 2) age 18 through 75 years, who were continuously enrolled during the measurement year, and who had an LDL-C test using claim/encounter or automated laboratory data. The LDL-C test must have a service date during the measurement year of the year prior to the measurement year.
Comprehensive Diabetes Care (HbA1c Screening)
Description: The percentage of members with diabetes (Type I or Type 2) age 18 through 75 years, who were continuously enrolled during the measurement year, and who had an LDL-C test using claim/encounter or automated laboratory data. The LDL-C test must have a service date during the measurement year or the year prior to the measurement year. this is correct for the April QBI, but the high lighted section will probably change in the September QBI to match what NCQA is doing (HEDIS Specs), and definitely will change for next April (09) QBI.
Monitoring of Patients on Persistent ACE/ARBs
Description: The percentage of members 18 years and older who received at least a 180-days supply of ACE inhibitors or ARBs during the measurement year and who had at least one serum potassium and either a serum creatinine or blood urea nitrogen monitoring test in the measurement year.