Quality of Care

We monitor quality of care through a nationally-standardized set of measures referred to as Healthcare Effectiveness and Data Information Set (HEDIS).

What is HEDIS?
The Healthcare Effectiveness Data and Information Set (HEDIS) was created by NCQA to provide employers, individuals and families with information that allows them to compare the performance of different health plans. Over 90 percent of all health insurance companies utilize HEDIS as a trusted source of standardized measures.

In 2015 Dean Health Plan performed above the national 90th percentile (within the top 10%) in the following HEDIS measures:

Adult Body Mass Index (BMI) Assessment
Measures percent of members 18-74 whose BMI was documented during an outpatient visit within the measurement year.

Adult BMI Assessment
Prevea 360 Health Plan 93.37%
90th Percentile  90.76%
 

Antidepresent Medication Management
Measures the percent of members 18 years of age and older who had a diagnosis of major depression, were treated with antidepressants, and remained on medication.

Effective Acute Phase Treatment
Prevea 360 Health Plan 77.49%
90th Percentile 75.15%

Cardiac Care
Measures percent of members who have had a cardiac episode or are at risk of an episode and are receiving the appropriate treatment and screenings.

Controlling High Blood Pressure
(Ages 18-85)
Prevea 360 Health Plan 81.85%
90th Percentile 75.13%

Diabetes Care
Measures percent of members diagnosed with diabetes who receive routine screenings and are at appropriate control levels to reduce health risks.

HbA1c Testing
Prevea 360 Health Plan 95.07%
90th Percentile 94.16%

HbA1c Control (<8%)
Prevea 360 Health Plan 68.07%
90th Percentile 67.54%

HbA1c Poor Control (lower percent is better)
Prevea 360 Health Plan 19.71%
90th Percentile 21.28%

Monitoring for Diabetic Nephropathy
Prevea 360 Health Plan 92.52%
90th Percentile 89.63%

Blood Pressure Control for Diabetic Members (<140/90)
Prevea 360 Health Plan 85.04%
90th Percentile 76.16%

Follow-up after Hospitalization for Mental Illness
Measures percent of members ages 6 and older who were discharged from the hospital after treatment of mental illness and had an outpatient visit.

Within 30 Days of Discharge
Prevea 360 Health Plan 87.54%

90th Percentile 83.78%

Human Papillomavirus (HPV) Vaccine for female adolsescents
Measures percent of female members who have had three doses of the HPV vaccine before their 13th birthday.

Human Papillomavirus (HPV)
Prevea 360 Health Plan 23.84%
90th Percentile 22.03%

Non-Recommended Cervical Cancer Screening in Adolescent Females
Measures percent of female members ages 16 to 20 who were screened for cervical cancer without cause. 

Non-Recommended Cervical Cancer Screening in Adolescent Females
(lower percent is better)
Prevea 360 Health Plan 1.19%
90th Percentile 1.47%

Prenatal and Postpartum Care—Postpartum Care
Measures percent of new-mom members who had a postpartum visit within 21 to 56 days after giving birth. 

Postpartum Care
Prevea 360 Health Plan 88.46%

90th Percentile 88.27%

Use of Imaging Studies for Lower Back Pain
Measures percent of members who did not have an imaging study (x-ray, MRI, CT scan) within 28 days of receiving a primary diagnosis of low back pain.

Use of Imaging Studies for Lower Back Pain
Prevea 360 Health Plan 83.21%

90th Percentile 83.20%

Weight Assessment and COunseling for Nutrition and Physical Activity for Children/Adolescents
Measures percent of members 3 to 17 years old who visited their PCp or OB/GYN as an outpatient and had counseling for nutrition, physical activity and BMI.

BMI Percentile Documentation
Prevea 360 Health Plan 83.17%
90th Percentile 82.98%