Quality Improvement Tip Sheets
We collect quality data from providers to measure and improve the care our members receive. Our tip sheets can help you satisfy quality measures. These include Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance and National Quality Forum measures.
Complying with these measures may reduce the need for you to provide medical records later for review.
Tip Sheets
- Adult Access to Preventive/Ambulatory Health Services
- Appropriate Testing for Pharyngitis
- Appropriate Treatment for Upper Respiratory Infection
- Asthma Medication Ratio
- Avoidance of Antibiotic Treatment for Acute Bronchitis
- Breast Cancer Screening
- Cervical Cancer Screening
- Child and Adolescent Well-Care Visits
- Childhood Immunization Status
- Children and Adolescents’ Access to Primary Care Practitioners HEDIS® Tip Sheet
- Chlamydia Screening in Women
- Colorectal Cancer Screening
- Comprehensive Diabetes Care
- Comprehensive Diabetes Care – HbA1c < 8%
- Comprehensive Diabetes Care – HbA1c Test
- Comprehensive Diabetes Care – Retinal Eye Exam
- Comprehensive Diabetes Care – Nephropathy
- Controlling High Blood Pressure
- Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
- Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction
- Excess Days in Acute Care after Hospitalization for Heart Failure
- Excess Days in Acute Care after Hospitalization for Pneumonia
- Follow-Up After Emergency Department Visit for People with High-Risk Multiple Chronic Conditions
- Immunizations For Adolescents
- Kidney Health Evaluation for Patients with Diabetes
- Lead Screening in Children
- Medication Management for People with Asthma
- Metabolic Monitoring for Children and Adolescents on Antipsychotics
- Non-Recommended Cervical Cancer Screening in Adolescent Females
- Osteoporosis Management in Women Who Had a Fracture
- Pharmacotherapy Management of COPD Exacerbation
- Plan All-Cause Readmissions
- Potentially Harmful Drug-Disease Interactions in the Elderly
- Prenatal and Postpartum Care
- Primary Open-Angle Glaucoma
- Statin Therapy for Patients with Cardiovascular Disease
- Use of Imaging Studies for Low Back Pain
- Use of Opioids from Multiple Providers
- Use of Spirometry Testing in the Assessment and Diagnosis of COPD
- Well-Child Visits in the First 30 months of Life
Behavioral Health Tip Sheets
- Antidepressant Medication Management (AMM)
- Diabetes Screening for Members Taking Antipsychotics (SSD)
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Follow-Up after Hospitalization for Mental Illness (FUH)
- Follow-Up Care for Children Prescribed ADHD Medication (ADD)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
- Treatment for Alcohol and Other Drugs (IET)
- Use of Opioids from Multiple Providers (UOP)
HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here . The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.
* Measurement Year (MY) 2020 and MY 2021
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.
