Author: MM_ADMIN

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents  – The percentage of members 3–17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year.

•  BMI percentile documentation*.

•  Counseling for nutrition.

•  Counseling for physical activity.

 

* Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.

 

Further reading –

https://providers.amerigroup.com/ProviderDocuments/KSKS_HEDIS_WellChildVisitsWeightAssessment.pdf

Well-Care Visits in the First 15 Months of Life – The percentage of members who turned 15 months old during the measurement year and who had the following number of well-child visits with a PCP during their first 15 months of life: no well child visits, 1 well-child visit, 2 well-child visits, 3 well-child visits, 4 well-child visits, 5 well-child visits, 6 or more well-child visits.

Further reading –

https://www.qualitymeasures.ahrq.gov/summaries/summary/49819/wellchild-visits-in-the-first-15-months-of-life-percentage-of-members-who-turned-15-months-old-during-the-measurement-year-and-who-had-the-following-number-of-wellchild-visits-with-a-pcp-during-their-first-15-months-of-life-zero-one-two-three-four-five-six-or-

Upper Respiratory Infection – Appropriate Treatment for Children With Upper Respiratory Infection . The percentage of children 3 months–18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. *The measure is reported as an inverted rate [1 – (numerator/eligible population)]. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed).

Further reading –

https://providers.optimahealth.com/clinicalreference/Pages/Avoidance-of-Antibiotic-Use.aspx

Prenatal and Postpartum Care – The percentage of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care. • Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization. Postpartum Care- The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.

Further reading –

https://www.medicaid.gov/medicaid/quality-of-care/downloads/strategies-to-improve-postpartum-care.pdf

Managed behavioral healthcare organizations (MBHO) can be independent organizations, can be part of a health plan or can be supported by health care providers. All have a common focus: deliver value. Key strategies for accomplishing this include network development, performance measurement, managing utilization, coordinating care and setting payment rates. Managed behavioral healthcare organizations (MBHO) can be independent organizations, can be part of a health plan or can be supported by health care providers. All have a common focus: deliver value.
Key strategies for accomplishing this include network development, performance measurement, managing utilization, coordinating care and setting payment rates.

Further reading –

https://prezi.com/0vo1evondfjr/managed-behavioral-healthcare-organizations-mbho/

Immunizations for Adolescents – The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday.

Further reading –

http://www.ncqa.org/portals/0/Immunizations%20for%20Adolescents.pdf

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment – The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) dependence who received the following.

• Initiation of AOD Treatment. The percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.

• Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit.

Further reading –

https://www.mhswi.com/content/dam/centene/MHSWI/Providers/PDFs/WI_Medicaid_(IET)_Provider_03_31_17%20BRIEF%20FINAL.pdf

Follow-Up After Hospitalization for Mental Illness – The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported: • The percentage of discharges for which the member received follow-up within 7 days of discharge.

Further reading –

http://www.ncqa.org/portals/0/Follow-Up%20After%20Hospitalization%20for%20Mental%20Illness.pdf