Healthcare Effectiveness Data and Information Set (HEDIS)
HEDIS is a set of standardized performance measures the National Committee for Quality Assurance (NCQA)
developed to allow for comparison across health plans based on quality, not just cost.
Your HEDIS scores can also help you understand how you compare to other Network Health providers, as well as
to the national average. By working together, we can ensure your Network Health patients, our members, receive
optimal preventive and quality care.
HEDIS 2012 hybrid measures and specifications
Preventive health care
Frequency of ongoing prenatal care Received at least 81% of expected prenatal visits
Timeliness of prenatal care
Received a prenatal care visit during first trimester or within 42 days of Network Health enrollment
Timeliness of postpartum care
Received a postpartum visit 21 to 56 days after delivery
Childhood immunizations
Ages: 0 – 2 years old
Received the following immunizations by second birthday:
• One chicken pox (VZV)
• One measles, mumps, and rubella (MMR)
• Two hepatitis A (HepA)
• Two influenza (flu) vaccines
• Two or three rotavirus (RV)
• Three H influenza type B (HiB)
• Three hepatitis B (HepB)
• Three polio (IPV)
• Four diphtheria, tetanus, and acellular pertussis (DTaP)
• Four pneumococcal conjugate (PCV)
Lead screening in children
Ages: 0 – 2 years old
Received one or more capillary or venous lead blood tests for lead poisoning by second birthday
Well-child visits
Ages: 0 – 15 months old
Received at least six well-child visits with PCP within first 15 months of life
Well-child visits
Ages: 3 – 6 years old
Received one or more annual well-child visits with PCP
Adolescent well visits
Ages: 12 – 21 years old
Received at least one annual comprehensive well visit with PCP or OB/GYN
Adolescent immunizations
Received the following immunizations by 13th birthday:
• One meningococcal
• One tetanus, diphtheria toxoids, and acellular pertussis (Tdap)
Or:
• One tetanus, diphtheria toxoids (Td)
HPV vaccine
Received three doses of the human papillomavirus (HPV) vaccine by 13th birthday
Cervical cancer screening(s)
Ages: 21 – 64 years old
Received one or more Pap tests in 2009, 2010, or 2011
Weight counseling for nutrition
and physical activity
Ages: 3 – 17 years old
BMI assessment
Ages: 18 – 74 years old
Received an outpatient visit with a PCP or OB/GYN and had evidence of the following during the
measurement year:
• Body mass index (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.
Received an outpatient visit and BMI was documented in 2010 or 2011
Continued on other side.
Condition-specific care
Cholesterol management
For Network Health patients with
cardiovascular conditions
Ages: 18 – 75 years old
Received:
• LDL-C screening
• LDL-C control (< 100 mg/dl)*
*Must report most-recent values
Comprehensive diabetes care
For Network Health patients with Type
1 or Type 2 diabetes
Ages: 18 – 75 years old
Received:
• HbA1c tests and values*
• Dilated eye exam for diabetic retinal disease
• LDL-C tests and values*
• Nephropathy screening
• Blood pressure (BP) control monitoring*
*Must report most-recent values
High blood pressure control
Ages: 18 – 85 years old
Received hypertension (HTN) diagnosis and had adequately controlled BP*
*Must report most-recent values
Please note: Measurement year is January 1, 2011 to December 31, 2011, unless otherwise indicated.
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