Quality Improvement Program

Quality Improvement Annual Summary Reports

HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS includes more than 90 measures across 6 domains of care. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis. Health plans also use HEDIS results themselves to see where they need to focus their improvement efforts.

HEDIS measures address a broad range of important health issues. Among them are the following:

  • Asthma Medication Use
  • Persistence of Beta-Blocker Treatment after a Heart Attack
  • Controlling High Blood Pressure
  • Comprehensive Diabetes Care
  • Breast Cancer Screening
  • Anti-depressant Medication Management
  • Childhood and Adolescent Immunization Status
  • Childhood and Adult Weight/BMI Assessment

CAHPS

The CAHPS Health Plan Survey is a tool for collecting standardized information on enrollees' experiences with health plans and their services. Since its launch in 1997, this survey has become the national standard for measuring and reporting on the experiences of consumers with their health plans. A version of this survey is conducted in almost every State in the U.S.

CAHPS measures health care consumers' satisfaction with the quality of care and customer service provided by their health plan. Denver Health Medical Plan utilizes the mixed mail/telephone protocol. This protocol includes mailing a questionnaire with a cover letter, followed by a thank you/reminder postcard. For those selected members who did not respond to the first questionnaire, a second questionnaire with a cover letter encouraging participation is sent which is also followed by a reminder postcard. If a selected member still does not respond to the questionnaire, at least four telephone calls are made to complete the survey using trained telephone interviewers. NCQA originally designed this protocol with the goal of achieving a total response rate of at least fifty-five percent (55%).

Interventions

DHMP Open Shopper activity will continue in 2020 to evaluate the appointment making process within the ACS clinics, pharmacy, and the Specialty Appointment clinics. The scope of Open Shopper has expanded to include our extended network facilities. To improve member satisfaction the QI staff has employed strategies to increase CAHPS and HEDIS scores when there is appropriate correlations. To improve CAHPS member satisfaction and HEDIS measure rates for annual well visits for adults and children, some clinics will be holding clinical hours on Saturdays. Provider education training on CAHPS and HEDIS will be developed around gaps in knowledge.

Commercial HEDIS Rates for Denver Health Medical Plan, Inc.
HEDIS Measure HEDIS 2016 HEDIS 2017 HEDIS 2018 GOAL
Well-child Visits in the First 15 Months of Life (W15) 73.55% 81.15% BR* 84%
Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) 74.17% 77.99% 83.54% 86%
Adolescent Well-Care Visits (AWC) 41.13% 43.21% 48.60% 51%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI 71.53% 91.24% 88.08% 91%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition 71.53% 80.05% 79.81% 82%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity 57.66% 63.50% 68.61% 71%

Commercial HEDIS Rates for Denver Health Medical Plan, Inc.

HEDIS Measure: Well-child Visits in the First 15 Months of Life (W15)

  • HEDIS 2016: 73.55%
  • HEDIS 2017: 81.15%
  • HEDIS 2018: BR*
  • GOAL: 84%

HEDIS Measure: Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34)

  • HEDIS 2016: 74.17%
  • HEDIS 2017: 77.99%
  • HEDIS 2018: 83.54%
  • GOAL: 86%

HEDIS Measure: Adolescent Well-Care Visits (AWC)

  • HEDIS 2016: 41.13%
  • HEDIS 2017: 43.21%
  • HEDIS 2018: 48.60%
  • GOAL: 51%

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI

  • HEDIS 2016: 71.53%
  • HEDIS 2017: 91.24%
  • HEDIS 2018: 88.08%
  • GOAL: 91%

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition

  • HEDIS 2016: 71.53%
  • HEDIS 2017: 80.05%
  • HEDIS 2018: 79.81%
  • GOAL: 82%

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity

  • HEDIS 2016: 57.66%
  • HEDIS 2017: 63.50%
  • HEDIS 2018: 68.61%
  • GOAL: 71%
* BR= Biased Rate- removed for biased results
CHP+ HEDIS Rates for Denver Health Medical Plan, Inc.
HEDIS Measure *HEDIS 2016 *HEDIS 2017 *HEDIS 2018 GOAL
Well-child Visits in the First 15 Months of Life (W15) 46.00% 6.78% N/A 9%
Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) 61.17% 59.48% 46.64% 49%
Adolescent Well-Care Visits (AWC) 48.42% 41.37% 37.64% 40%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI 77.86% 7.94% 17.71% 20%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition 78.59% 1.46% 6.41% 9%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity 65.21% 0.80% 1.40% 4%

CHP+ HEDIS Rates for Denver Health Medical Plan, Inc.

HEDIS Measure: Well-child Visits in the First 15 Months of Life (W15)

  • HEDIS 2016*: 46.00%
  • HEDIS 2017*: 6.78%
  • HEDIS 2018*: N/A
  • GOAL: 9%

HEDIS Measure: Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34)

  • HEDIS 2016*: 61.17%
  • HEDIS 2017*: 59.48%
  • HEDIS 2018*: 46.64%
  • GOAL: 49%

HEDIS Measure: Adolescent Well-Care Visits (AWC)

  • HEDIS 2016*: 48.42%
  • HEDIS 2017*: 41.37%
  • HEDIS 2018*: 37.64%
  • GOAL: 40%

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI

  • HEDIS 2016*: 77.86%
  • HEDIS 2017*: 7.94%
  • HEDIS 2018*: 17.71%
  • GOAL: 20%

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition

  • HEDIS 2016*: 78.59%
  • HEDIS 2017*: 1.46%
  • HEDIS 2018*: 6.41%
  • GOAL: 9%

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity

  • HEDIS 2016*: 65.21%
  • HEDIS 2017*: 0.80%
  • HEDIS 2018*: 1.40%
  • GOAL: 4%
* The asterisk represents Administrative data only.
Medicare HEDIS Rates for Denver Health Medical Plan, Inc.
HEDIS Measure HEDIS 2016 HEDIS 2017 HEDIS 2018 GOAL
Breast Cancer Screening 70.83% 71.25% 71.80% 74%
Controlling High Blood Pressure 69.34% 74.94% 73.24% 76%
Adult BMI Assessment 96.11% 98.05% 98.30% 99%
Comprehensive Diabetes Care: Eye Exam (Retinal) Performed 67.88% 67.88% 76.89% 79%
Colorectal Cancer Screening 67.40% 60.58% 62.77% 65%

Medicare HEDIS Rates for Denver Health Medical Plan, Inc.

HEDIS Measure: Breast Cancer Screening

  • HEDIS 2016: 70.83%
  • HEDIS 2017: 71.25%
  • HEDIS 2018: 71.80%
  • GOAL: 74%

HEDIS Measure: Controlling High Blood Pressure

  • HEDIS 2016: 69.34%
  • HEDIS 2017: 74.94%
  • HEDIS 2018: 73.24%
  • GOAL: 76%

HEDIS Measure: Adult BMI Assessment

  • HEDIS 2016: 96.11%
  • HEDIS 2017: 98.05%
  • HEDIS 2018: 98.30%
  • GOAL: 99%

HEDIS Measure: Comprehensive Diabetes Care: Eye Exam (Retinal) PerformedI

  • HEDIS 2016: 67.88%
  • HEDIS 2017: 67.88%
  • HEDIS 2018: 76.89%
  • GOAL: 79%

HEDIS Measure: Colorectal Cancer Screening

  • HEDIS 2016: 67.40%
  • HEDIS 2017: 60.58%
  • HEDIS 2018: 62.77%
  • GOAL: 65%
Improving Well-Child Visits
Intervention Description of Activities
Healthy Hero Birthday Postcards Children 2-19 years of age receive a birthday card informing them to come for their annual visit. These mailings have been going out to members since January 2009.
QI team amended the Healthy Heroes Birthday cards in 2014 to include a checklist of developmental topics the provider will cover in the well-child visit as a way of engaging the member to participate in care.
Provider Education on HEDIS Documentation To improve medical record documentation for well-child visit and Weight Assessment and Counseling for Physical Activity and Nutrition (WCC) measures, the QI team provides ongoing provider education by giving presentations and creating toolkits on compliant documentation.

Improving Well-Child Visits (Description of Activities)

Intervention: Healthy Hero Birthday Postcards

  • Children 2-19 years of age receive a birthday card informing them to come for their annual visit. These mailings have been going out to members since January 2009.

    QI team amended the Healthy Heroes Birthday cards in 2014 to include a checklist of developmental topics the provider will cover in the well-child visit as a way of engaging the member to participate in care.

Intervention: Provider Education on HEDIS Documentation

  • Children 2-19 years of age receive a birthday card informing them to come for their annual visit. These mailings have been going out to members since January 2009.
    QI team amended the Healthy Heroes Birthday cards in 2014 to include a checklist of developmental topics the provider will cover in the well-child visit as a way of engaging the member to participate in care.
Commercial HEDIS Rates for Denver Health Medical Plan, Inc.
HEDIS Measure HEDIS 2016 HEDIS 2017 HEDIS 2018 GOAL
Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care 95.98% 96.28% 96.22% 99%
Prenatal and Postpartum Care (PPC) – Postpartum Care 81.41% 80.17% 84.03% 87%

Commercial HEDIS Rates for Denver Health Medical Plan, Inc.

HEDIS Measure: Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care

  • HEDIS 2016: 95.98%
  • HEDIS 2017: 96.28%
  • HEDIS 2018: 96.22%
  • GOAL: 99%

HEDIS Measure: Prenatal and Postpartum Care (PPC) – Postpartum Care

  • HEDIS 2016: 81.41%
  • HEDIS 2017: 80.17%
  • HEDIS 2018: 84.03%
  • GOAL: 87%
Improving Adult Screening Visits
Invervention Description of Activities
Breast Cancer Screening All women 50-69 years old, who are in need of a mammogram, are sent a mailer reminding them to schedule an appointment. Members have the option to either get their mammogram from the radiology clinic on the main Denver Health campus or utilize the Denver Health Women’s Mobile Clinic.
Diabetic Eye Exams All diabetic members who are in need of a diabetic eye exam are targeted for outreach to schedule an appointment. Medicare members have the option to utilize Denver Health’s eye clinic or One Hour optical for exams.

Improving Adult Screening Visits

Intervention: Breast Cancer Screening

  • All women 50-69 years old, who are in need of a mammogram, are sent a mailer reminding them to schedule an appointment. Members have the option to either get their mammogram from the radiology clinic on the main Denver Health campus or utilize the Denver Health Women’s Mobile Clinic.

Intervention: Diabetic Eye Exams

  • All diabetic members who are in need of a diabetic eye exam are targeted for outreach to schedule an appointment. Medicare members have the option to utilize Denver Health’s eye clinic or One Hour optical for exams.