Secretary
STEPHEN R. RUSSO, JD.
Select Measure Group
Adherence to Antipsychotic Medications for Individuals with Schizophrenia
The percentage of members 18 years of age and older during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.
Why is this important?
It is important to take medicines as prescribed for schizophrenia to help keep it under control.
Antidepressant Medication Management
The percentage of members 18 years of age and older with a diagnosis of major depression and were newly treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported.
- Effective Acute Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 84 days (12 weeks).
- Effective Continuation Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 180 days (6 months).
Why is this important?
Taking medicines as prescribed for depression can help to improve well-being and can reduce risk of suicide.
Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
The percentage of members 18–64 years of age with schizophrenia or schizoaffective disorder and cardiovascular disease, who had an LDL-C test during the measurement year.
Why is this important?
People with schizophrenia are at an increased risk of developing heart disease. Appropriate cardiovascular care can improve their health and quality of life.
Diabetes Monitoring for People with Diabetes and Schizophrenia
The percentage of members 18–64 years of age with schizophrenia or schizoaffective disorder and diabetes who had both an LDL-C test and an HbA1c test during the measurement year.
Why is this important?
People with schizophrenia are at an increased risk of developing diabetes. Appropriate diabetic care can improve their health and quality of life.
Diabetes Screening for People With Schizophrenia or Bipolar Who Are Using Antipsychotic Medications
The percentage of members 18-64 years of age with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.
Why is this important?
For people taking antipsychotic medicines, it is important to be checked regularly to help prevent issues with diabetes.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence
The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit for AOD. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Why is this important?
Following up with a behavioral health provider after an emergency department visit can reduce substance use for people with a substance use disorder.
Follow-Up After Emergency Department Visit for Mental Illness
The percentage of emergency department (ED) visits for members 6 years of age and older with a diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Why is this important?
Following up with a behavioral health provider after an emergency department visit can improve the physical and mental health of people with mental illness.
Follow-Up After Hospitalization for Mental Illness
The percentage of discharges for members 6 years of age and older hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner within 7 days of discharge and within 30 days of discharge.
- Discharges for members that had a follow-up visit within 7 days after discharge.
- Discharges for members that had a follow-up visit within 30 days after discharge.
Why is this important?
It is important to see a behavioral health doctor for follow-up after a hospital stay for mental illness.
Follow-up Care for Children Prescribed ADHD Medication (ADD)
The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported.
- Initiation Phase. The percentage of members 6–12 years of age with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with a practitioner with prescribing authority during the 30-day Initiation Phase.
- Continuation and Maintenance (C&M) Phase. The percentage of members 6–12 years of age with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.
Why is this important?
Children taking ADHD medications should have checkups with their doctor to manage the medication appopriately.
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment
The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) abuse or 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, telehealth or medication treatment within 14 days of the diagnosis.
- Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional AOD services or medication treatment within 34 days of the initiation visit.
Why is this important?
People with alcohol or other substance abuse disorders who receive treatment have reduced mortality and improved health, productivity, and social outcomes.
Metabolic Monitoring for Children and Adolescents on Antipsychotics
The percentage of children and adolescents with ongoing antipsychotic medication use who had metabolic testing during the year.
Why is this important?
Antipsychotic medications can increase a child's risk for developing serious metabolic health complications later in life. Metabolic monitoring is important to ensure appropriate medication management.
Pharmacotherapy for Opioid Use Disorder
The percentage of new opioid use disorder (OUD) pharmacotherapy episodes that resulted in 180 or more covered treatment days among members 16 years of age and older with a diagnosis of OUD.
Why is this important?
People with opioid use disorder who are treated with pharmacotherapy are less likely to have withdrawal symptoms and are more likely to remain in treatment.
Use of First-Line Psychosocial Care for Children and Adolescent son Antipsychotics
The percentage of children and adolescents 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.
Why is this important?
Antipsychotic medications are often prescribed for nonpsychotic conditions. First-line psychosocial treatment may be utilized before antipsychotic medication to reduce the risks to children and adolescents.
Child and Adolescent Well-Care Visits
The percentage of members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
- 3-11 years
- 12-17 years
- 18-21 years
- Total
Why is this important?
Seeing a doctor regularly for checkups and screenings can help to keep children and adolescents healthy.
Childhood Immunization Status
The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.
- Combo 3 – DTaP, IPV, MMR, HiB, HepB, VZV, PCV
Why is this important?
It is recommended that children receive their shots as scheduled to help prevent diseases.
Developmental Screening in the First Three Years of Life
The percentage of children screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding or on their first, second, or third birthday.
Why is this important?
Developmental screening can identify children at risk for developmental delays. Identification paired with early intervention services give children the greatest opportunity for healthy development.
Immunization Status for Adolescents
Percentage of adolescents that turned 13 years old during the measurement year and had specific vaccines by their 13th birthday. Report all individual vaccine numerators and combinations.
- Combo 1: Meningococcal, Tdap
- Combo 2: Meningococcal, Tdap, and at least 2 HPV
- HPV
Why is this important?
It is recommended that teens receive their shots as scheduled to help prevent diseases.
Lead Screening in Children
The percentage of children 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday.
Why is this important?
Lead poisoning often goes unrecognized, and screening can provide early detection before damage to the brain and other vital organs occurs.
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Body Mass Index Assessment 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
Why is this important?
Monitoring weight, body mass, and getting counseling on nutrition and staying active is important for children's health.
Well-Child Visits in the First 30 Months of Life
The percentage of members who had the following number of well-child visits with a PCP during the last 15 months.
The following rates are reported:
- Well-Child Visits in the First 15 Months. Children who turned 15 months old during the measurement year: Six or more well-child visits.
- Well-Child Visits for Age 15 Months–30 Months. Children who turned 30 months old during the measurement year: Two or more well-child visits.
Why is this important?
Seeing a doctor regularly for checkups and screenings can help to keep infants healthy.
Asthma in Younger Adults Admission Rate
Admissions for a principal diagnosis of asthma per 100,000 population, ages 18 to 39 years. Excludes admissions with an indication of cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions. Number of discharges for asthma per 100,000 member months for Medicaid enrollees ages 18 to 39.
Why is this important?
Seeing a doctor for asthma can help to prevent issues that may require hospital stays.
Comprehensive Diabetes Care - BP control (<140/90 mm Hg)
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with BP control (<140/90 mm Hg).
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - Eye exam (retinal) performed
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with an eye exam (retinal) performed.
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - HbA1c control (<8.0%)
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with HbA1c control (<8.0%).
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - HbA1c poor control (>9.0%)
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with HbA1c poor control (>9.0%).
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - Hemoglobin A1c (HBA1c) testing
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with a Hemoglobin A1c (HbA1c) test.
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Controlling High Blood Pressure-Total
The percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year.
Why is this important?
Keeping blood pressure under control is important to help prevent major health issues such as strokes, heart attacks, and kidney failure.
COPD and Asthma in Older Adults Admission Rate
This measure is used to assess the number of admissions for chronic obstructive pulmonary disease (COPD) per 100,000 population. The number of discharges for chronic obstructive pulmonary disease (COPD) or asthma per 100,000 member months for Medicaid enrollees age 40 and older.
Why is this important?
Seeing a doctor for asthma or COPD in older adults can help to prevent issues that may require hospital stays.
Diabetes Short Term Complications Admission Rate
Number of discharges for diabetes short term complications per 100,000 member months per Medicaid enrollees age 18 and older.
Why is this important?
Seeing a doctor for diabetes can help to prevent issues that may require hospital stays.
Heart Failure Admission Rate
Percent of population with an admissions for heart failure. The number of discharges for heart failure per 100,000 member months for Medicaid enrollees age 18 and older.
Why is this important?
Seeing a doctor for congestive heart failure can help to prevent issues that may require hospital stays.
HIV Viral Load Suppression
Percentage of patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200.
Why is this important?
It is important that people with HIV have regular tests to see if it is being controlled well.
Medical Assistance With Smoking and Tobacco Use Cessation
Assesses different facets of providing medical assistance with smoking and tobacco use cessation.
MCOs will report three components (questions):
MCOs will report three components (questions):
- Advising Smokers and Tobacco Users to Quit
- Discussing Cessation Medications
- Discussing Cessation Strategies
Why is this important?
It is important to seek a doctor's help to successfully quit smoking or using tobacco.
Statin Therapy for Patients with Cardiovascular Disease – Received Statin Therapy: Total
The percentage of males 21-75 years of age and females 40-75 years of age during the measurement year, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and who received statin therapy (were dispensed at least one high or moderate-intensity statin medication during the measurement year.)
Why is this important?
It is especially important for people with diabetes to take their statin medicines to lower cholesterol.
Ambulatory Care - Emergency Department Visits
This measure summarizes utilization of ambulatory care ED Visits per 1,000 member months.
Why is this important?
Seeing a doctor regularly for checkups and screenings is important to stay healthy and can reduce unneccessary emergency room visits.
Ambulatory Care - Outpatient Visits
Measures the usage of ambulatory outpatient visits per 1000 member months.
Why is this important?
Seeing a doctor regularly for checkups and screenings is important to stay healthy and can reduce emergency room visits.
Plan All-Cause Readmissions
For members 18 - 64 years of age, the risk-adjusted rate of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days.
- Observed Readmission (Num/Den)
- Expected Readmissions Rate
- Observed-to-Expected Ratio (Observed Readmission/Expected Readmissions)
Why is this important?
Receiving appropriate care during and after a hospital stay can help prevent getting sick again and having to go back to the hospital.
CAHPS Health Plan Survey 5.0H, Adult (Rating of Health Plan, 8+9+10)
CAHPS - Consumer Assesment of Healthcare Providers and Systems
This measure provides information on the experiences of Medicaid members with the organization and gives a general indication of how well the organization meets members’ expectations.
Why is this important?
CAHPS surveys show if members are satisfied with their health plan.
CAHPS Health Plan Survey 5.0H, Child (Rating of Health Plan-General Population, 8+9+10)
CAHPS - Consumer Assessment of Healthcare Providers and Systems
This measure provides information on parents’ experience with their child’s Medicaid organization.
Why is this important?
CAHPS surveys show if members are satisfied with their health plan.
Self-Reported Overall Health (Adult and Child)
The percentage of members reporting overall excellent or very good health. This question asks about:
- In general, how would you rate your overall health?
Why is this important?
Self-Reported Overall Health provides valuable feedback on the physical health of the patient population. This information helps healthcare providers and systems develop prevention and treatment strategies that address patients' physical health needs.
Self-Reported Overall Mental or Emotional Health (Adult and Child)
The percentage of members reporting overall excellent or very good mental or emotional health. This question asks about:
- In general, how would you rate your overall mental or emotional health?
Why is this important?
Self-Reported Overall Mental or Emotional Health provides valuable feedback on the mental or emotional health of the patient population. This information helps healthcare providers and systems develop prevention and treatment strategies that address patients' mental and emotional health needs.
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.
Why is this important?
Most Upper Respiratory Infections (URIs) are caused by viruses and require no antibiotic treatment. Increased education and awareness of the appropriate treatment for URIs can reduce the danger of antibiotic-resistant bacteria.
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
The percentage of adults 18–64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription.
Why is this important?
Acute bronchitis almost always get better on its own without antibiotic treatment. Increased education and awareness of the appropriate treatment for acute bronchititis can reduce the danger of antibiotic-resistant bacteria.
Non-Recommended Cervical Cancer Screening in Adolescent Females
The percentage of adolescent females 16–20 years of age who were screened unnecessarily for cervical cancer.
Why is this important?
Cervical Cancer Screening in adolescent females can often produce false-positive results and lead to unnecessary tests and treatment.
Use of Imaging Studies for Low Back Pain
The percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.
Why is this important?
Most people with low back pain improve within the first two weeks. Avoiding imaging for patients when there is no indication of an underlying condition can prevent unnecessary harm and unintended consequences to patients and can reduce health care costs.
Adults’ Access to Preventive/Ambulatory Health Services
The percentage of members age 20 years and older who had an ambulatory or preventive care visit during the measurement year. Three age stratifications and a total rate are reported:
- 20-44 years
- 45-64 years
- 65 years and older
- Total
Why is this important?
Seeing a doctor regularly for checkups and screenings can help you stay healthy.
Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer.
Why is this important?
Women should receive breast cancer screenings as recommended by their doctor for early detection and treatment.
Cervical Cancer Screening
Percentage of women 21–64 years of age who were screened for cervical cancer:
- Women age 21-64 who had cervical cytology performed every 3 years.
- Women age 30-64 who had cervical cytology/HPV co-testing performed every 5 years.
Why is this important?
Women should receive cervical cancer screenings as recommended by their doctor for early detection and treatment.
Colorectal Cancer Screening
The percentage of members 50-75 years of age who had appropriate screening for colorectal cancer.
Why is this important?
Adults should receive colorectal cancer screenings as recommended by their doctor for early detection and treatment.
Flu Vaccinations for Adults Ages 18 to 64
The percentage of adults 18 years of age and older who self-report receiving an influenza vaccine within the measurement period.
Why is this important?
Flu shots can help to prevent flu.
Hepatitis C Virus Screening
Percentage of eligible individuals screened for hepatitis C virus infection.
Why is this important?
Hepatitis C screening can lead to earlier treatment that can prevent progression of liver disease.
Cesarean Rate for Low-Risk First Birth Women
The percentage of cesareans in live births at or beyond 37.0 weeks gestation to women that are having their first delivery and are singleton (no twins or beyond) and are vertex presentation (no breech or transverse positions).
Why is this important?
Avoiding unnecessary C-section deliveries without a medical reason can reduce risks to the mother and baby.
Chlamydia Screening in Women
The percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for Chlamydia during the measurement year.
Why is this important?
Chlamydia screenings are needed to be able to identify it so it can be treated.
Contraceptive Care-All Women (ages 21-44)
The percentage of women ages 21-44 who are at risk of unintended pregnancy and were provided a most or moderately effective method of contraception or were provided a LARC. Two rates are reported.
- Contraceptive Care-All Women (ages 21-44) LARC
- Contraceptive Care-All Women (ages 21-44) Most/Moderate
Why is this important?
Unintended pregnancy is linked to preterm birth and postpartum depression. Use of birth control is critical in preventing unintended pregnancy.
Contraceptive Care-Postpartum (ages 21-44)
The percentage of women ages 21-44 who had a live birth and were provided a most or moderately effective method of contraception within 3 and 60 days of delivery. Four rates are reported.
- Contraceptive Care-Postpartum (ages 21-44) LARC 3 Days
- Contraceptive Care-Postpartum (ages 21-44) LARC 60 Days
- Contraceptive Care-Postpartum (ages 21-44) Most/Moderate 3 Days
- Contraceptive Care-Postpartum (ages 21-44) Most/Moderate 60 Days
Why is this important?
Receiving contraceptives after a pregnancy can help to space out pregnancies.
Percentage of low birth weight births
Percentage of live births that weighted less than 2,500 grams in the state during the reporting period.
Why is this important?
Babies with low birth weight face more risks and health issues.
Prenatal and Postpartum Care - Postpartum Care
The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year that had a postpartum visit on or between 7 and 84 days after delivery.
Why is this important?
It is important for both the mother's health and the baby's health to have checkups during and after the pregnancy.
Prenatal and Postpartum Care - Timeliness of Prenatal Care
The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization.
Why is this important?
It is important for both the mother's health and the baby's health to have checkups during and after the pregnancy.
Coordination of Care
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often did your personal doctor seem informed and up to-date about the care you got from these doctors or other health providers?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Customer Service
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often did your health plan’s customer service give you the information or help you needed?
- In the last 6 months, how often did your health plan’s customer service staff treat you with courtesy and respect?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Getting Care Quickly
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, when you needed care right away, how often did you get care as soon as you needed?
- In the last 6 months, how often did you get an appointment for a check-up or routine care as soon as you needed?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Getting Needed Care Quickly
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often was it easy to get the care, tests, or treatment you needed?
- In the last 6 months, how often did you get an appointment with a specialist as soon as you needed?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
How Well Doctors Communicate
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?
- In the last 6 months, how often did your personal doctor listen carefully to you?
- In the last 6 months, how often did your personal doctor show respect for what you had to say?
- In the last 6 months, how often did your personal doctor spend enough time with you?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Health Care
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate all your health care in the last 6 months?
The values displayed here represent any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Health Plan
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate your health plan?
The values displayed here represent any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Personal Doctor
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate your personal doctor?
The values displayed here represent any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Specialist
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate that specialist?
The values displayed here represent any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Adolescent Well-Care Visits
The percentage of enrolled members 12-21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
Why is this important?
Seeing a provider regularly for checkups and screenings can help to keep teens healthy.
Adult BMI Assessment
The percentage of members 18-74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement or the year prior to the measurement year.
Why is this important?
Monitoring weight and body mass can tell you whether a person's weight is in a healthy range.
Annual Monitoring for Patients on Persistent Medications
The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. For each product line, report each of the two rates separately and as a total rate.
Why is this important?
People taking certain medications should have regular tests to prevent and diagnose problems.
Asthma Medication Ratio-Total
The percentage of patients 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.
Why is this important?
Using effective medicines for asthma can improve health and quality of life.
Childhood and Adolescents Access to Primary Care Practitioners
Percentage of children ages 12 months – 19 years who had a visit with a PCP. The MCO reports four separate percentages:
- Children 12-24 months and 25 months – 6 years who had a visit with a PCP in the measurement year.
- Children 7-11 years and adolescents 12-19 years who had a visit with a PCP in the measurement year or the year prior to the measurement year.
Why is this important?
Seeing a doctor regularly for checkups and screenings can help to keep children and teens healthy.
Childhood Immunization Status
The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.
- Combo 2 – DTaP, IPV, MMR, HiB, HepB, VZV
Why is this important?
It is recommended that children receive their shots as scheduled to help prevent diseases.
Comprehensive Diabetes Care - Medical attention for nephropathy
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with medical attention for nephropathy.
Why is this important?
It is important for people with diabetes to have regular checkups to help prevent and diagnose problems like blindness, kidney disease, and heart disease.
Elective Delivery
This measure assesses patients with elective vaginal deliveries or elective cesarean sections at >= 37 and < 39 weeks of gestation completed
Why is this important?
Reducing early deliveries without a medical reason can reduce risks to the baby.
Initiation of Injectable Progesterone for Preterm Birth Prevention
The percentage of women 15-45 years of age with evidence of a previous preterm singleton birth event (24-36 weeks completed gestation) who received one or more progesterone injections between the 16th and 24th week of gestation for deliveries during the measurement year.
Why is this important?
For women who have already had a preterm birth, it is important for them to receive progesterone injections if their doctor recommends them.
Medication Management for People with Asthma
The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on during the treatment period. Two rates are reported.
Why is this important?
Using effective medicines for asthma can improve health and quality of life.
Well-Child Visits in the First 15 Months of Life - Six or More Well Child Visits
The percentage of members who turned 15 months old during the measurement year and who had six or more well-child visits with a PCP during their first 15 months of life.
Why is this important?
Seeing a provider regularly for checkups and screenings can help to keep infants healthy.
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
The percentage of members 3-6 years of age who had one or more well-child visits with a PCP during the measurement year.
Why is this important?
Seeing a provider regularly for checkups and screenings can help to keep children healthy.
Adherence to Antipsychotic Medications for Individuals with Schizophrenia
The percentage of members 18 years of age and older during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.
Why is this important?
It is important to take medicines as prescribed for schizophrenia to help keep it under control.
Antidepressant Medication Management
The percentage of members 18 years of age and older with a diagnosis of major depression and were newly treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported.
- Effective Acute Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 84 days (12 weeks).
- Effective Continuation Phase Treatment. The percentage of members who remained on an antidepressant medication for at least 180 days (6 months).
Why is this important?
Taking medicines as prescribed for depression can help to improve well-being and can reduce risk of suicide.
Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
The percentage of members 18–64 years of age with schizophrenia or schizoaffective disorder and cardiovascular disease, who had an LDL-C test during the measurement year.
Why is this important?
People with schizophrenia are at an increased risk of developing heart disease. Appropriate cardiovascular care can improve their health and quality of life.
Diabetes Monitoring for People with Diabetes and Schizophrenia
The percentage of members 18–64 years of age with schizophrenia or schizoaffective disorder and diabetes who had both an LDL-C test and an HbA1c test during the measurement year.
Why is this important?
People with schizophrenia are at an increased risk of developing diabetes. Appropriate diabetic care can improve their health and quality of life.
Diabetes Screening for People With Schizophrenia or Bipolar Who Are Using Antipsychotic Medications
The percentage of members 18-64 years of age with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.
Why is this important?
For people taking antipsychotic medicines, it is important to be checked regularly to help prevent issues with diabetes.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence
The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit for AOD. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Why is this important?
Following up with a behavioral health provider after an emergency department visit can reduce substance use for people with a substance use disorder.
Follow-Up After Emergency Department Visit for Mental Illness
The percentage of emergency department (ED) visits for members 6 years of age and older with a diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Why is this important?
Following up with a behavioral health provider after an emergency department visit can improve the physical and mental health of people with mental illness.
Follow-Up After Hospitalization for Mental Illness
The percentage of discharges for members 6 years of age and older hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner within 7 days of discharge and within 30 days of discharge.
- Discharges for members that had a follow-up visit within 7 days after discharge.
- Discharges for members that had a follow-up visit within 30 days after discharge.
Why is this important?
It is important to see a behavioral health doctor for follow-up after a hospital stay for mental illness.
Follow-up Care for Children Prescribed ADHD Medication (ADD)
The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported.
- Initiation Phase. The percentage of members 6–12 years of age with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with a practitioner with prescribing authority during the 30-day Initiation Phase.
- Continuation and Maintenance (C&M) Phase. The percentage of members 6–12 years of age with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.
Why is this important?
Children taking ADHD medications should have checkups with their doctor to manage the medication appopriately.
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment
The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) abuse or 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, telehealth or medication treatment within 14 days of the diagnosis.
- Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional AOD services or medication treatment within 34 days of the initiation visit.
Why is this important?
People with alcohol or other substance abuse disorders who receive treatment have reduced mortality and improved health, productivity, and social outcomes.
Metabolic Monitoring for Children and Adolescents on Antipsychotics
The percentage of children and adolescents with ongoing antipsychotic medication use who had metabolic testing during the year.
Why is this important?
Antipsychotic medications can increase a child's risk for developing serious metabolic health complications later in life. Metabolic monitoring is important to ensure appropriate medication management.
Pharmacotherapy for Opioid Use Disorder
The percentage of new opioid use disorder (OUD) pharmacotherapy episodes that resulted in 180 or more covered treatment days among members 16 years of age and older with a diagnosis of OUD.
Why is this important?
People with opioid use disorder who are treated with pharmacotherapy are less likely to have withdrawal symptoms and are more likely to remain in treatment.
Use of First-Line Psychosocial Care for Children and Adolescent son Antipsychotics
The percentage of children and adolescents 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.
Why is this important?
Antipsychotic medications are often prescribed for nonpsychotic conditions. First-line psychosocial treatment may be utilized before antipsychotic medication to reduce the risks to children and adolescents.
Child and Adolescent Well-Care Visits
The percentage of members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
- 3-11 years
- 12-17 years
- 18-21 years
- Total
Why is this important?
Seeing a doctor regularly for checkups and screenings can help to keep children and adolescents healthy.
Childhood Immunization Status
The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.
- Combo 3 – DTaP, IPV, MMR, HiB, HepB, VZV, PCV
Why is this important?
It is recommended that children receive their shots as scheduled to help prevent diseases.
Developmental Screening in the First Three Years of Life
The percentage of children screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding or on their first, second, or third birthday.
Why is this important?
Developmental screening can identify children at risk for developmental delays. Identification paired with early intervention services give children the greatest opportunity for healthy development.
Immunization Status for Adolescents
Percentage of adolescents that turned 13 years old during the measurement year and had specific vaccines by their 13th birthday. Report all individual vaccine numerators and combinations.
- Combo 1: Meningococcal, Tdap
- Combo 2: Meningococcal, Tdap, and at least 2 HPV
- HPV
Why is this important?
It is recommended that teens receive their shots as scheduled to help prevent diseases.
Lead Screening in Children
The percentage of children 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday.
Why is this important?
Lead poisoning often goes unrecognized, and screening can provide early detection before damage to the brain and other vital organs occurs.
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Body Mass Index Assessment 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
Why is this important?
Monitoring weight, body mass, and getting counseling on nutrition and staying active is important for children's health.
Well-Child Visits in the First 30 Months of Life
The percentage of members who had the following number of well-child visits with a PCP during the last 15 months.
The following rates are reported:
- Well-Child Visits in the First 15 Months. Children who turned 15 months old during the measurement year: Six or more well-child visits.
- Well-Child Visits for Age 15 Months–30 Months. Children who turned 30 months old during the measurement year: Two or more well-child visits.
Why is this important?
Seeing a doctor regularly for checkups and screenings can help to keep infants healthy.
Asthma in Younger Adults Admission Rate
Admissions for a principal diagnosis of asthma per 100,000 population, ages 18 to 39 years. Excludes admissions with an indication of cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions. Number of discharges for asthma per 100,000 member months for Medicaid enrollees ages 18 to 39.
Why is this important?
Seeing a doctor for asthma can help to prevent issues that may require hospital stays.
Comprehensive Diabetes Care - BP control (<140/90 mm Hg)
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with BP control (<140/90 mm Hg).
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - Eye exam (retinal) performed
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with an eye exam (retinal) performed.
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - HbA1c control (<8.0%)
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with HbA1c control (<8.0%).
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - HbA1c poor control (>9.0%)
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with HbA1c poor control (>9.0%).
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Comprehensive Diabetes Care - Hemoglobin A1c (HBA1c) testing
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with a Hemoglobin A1c (HbA1c) test.
Why is this important?
It is important for people with diabetes to have regular checkups and screenings help prevent problems like blindness, kidney disease, high blood pressure, and stroke.
Controlling High Blood Pressure-Total
The percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year.
Why is this important?
Keeping blood pressure under control is important to help prevent major health issues such as strokes, heart attacks, and kidney failure.
COPD and Asthma in Older Adults Admission Rate
This measure is used to assess the number of admissions for chronic obstructive pulmonary disease (COPD) per 100,000 population. The number of discharges for chronic obstructive pulmonary disease (COPD) or asthma per 100,000 member months for Medicaid enrollees age 40 and older.
Why is this important?
Seeing a doctor for asthma or COPD in older adults can help to prevent issues that may require hospital stays.
Diabetes Short Term Complications Admission Rate
Number of discharges for diabetes short term complications per 100,000 member months per Medicaid enrollees age 18 and older.
Why is this important?
Seeing a doctor for diabetes can help to prevent issues that may require hospital stays.
Heart Failure Admission Rate
Percent of population with an admissions for heart failure. The number of discharges for heart failure per 100,000 member months for Medicaid enrollees age 18 and older.
Why is this important?
Seeing a doctor for congestive heart failure can help to prevent issues that may require hospital stays.
HIV Viral Load Suppression
Percentage of patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200.
Why is this important?
It is important that people with HIV have regular tests to see if it is being controlled well.
Medical Assistance With Smoking and Tobacco Use Cessation
Assesses different facets of providing medical assistance with smoking and tobacco use cessation.
MCOs will report three components (questions):
MCOs will report three components (questions):
- Advising Smokers and Tobacco Users to Quit
- Discussing Cessation Medications
- Discussing Cessation Strategies
Why is this important?
It is important to seek a doctor's help to successfully quit smoking or using tobacco.
Statin Therapy for Patients with Cardiovascular Disease – Received Statin Therapy: Total
The percentage of males 21-75 years of age and females 40-75 years of age during the measurement year, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and who received statin therapy (were dispensed at least one high or moderate-intensity statin medication during the measurement year.)
Why is this important?
It is especially important for people with diabetes to take their statin medicines to lower cholesterol.
Ambulatory Care - Emergency Department Visits
This measure summarizes utilization of ambulatory care ED Visits per 1,000 member months.
Why is this important?
Seeing a doctor regularly for checkups and screenings is important to stay healthy and can reduce unneccessary emergency room visits.
Ambulatory Care - Outpatient Visits
Measures the usage of ambulatory outpatient visits per 1000 member months.
Why is this important?
Seeing a doctor regularly for checkups and screenings is important to stay healthy and can reduce emergency room visits.
Plan All-Cause Readmissions
For members 18 - 64 years of age, the risk-adjusted rate of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days.
- Observed Readmission (Num/Den)
- Expected Readmissions Rate
- Observed-to-Expected Ratio (Observed Readmission/Expected Readmissions)
Why is this important?
Receiving appropriate care during and after a hospital stay can help prevent getting sick again and having to go back to the hospital.
CAHPS Health Plan Survey 5.0H, Adult (Rating of Health Plan, 8+9+10)
CAHPS - Consumer Assesment of Healthcare Providers and Systems
This measure provides information on the experiences of Medicaid members with the organization and gives a general indication of how well the organization meets members’ expectations.
Why is this important?
CAHPS surveys show if members are satisfied with their health plan.
CAHPS Health Plan Survey 5.0H, Child (Rating of Health Plan-General Population, 8+9+10)
CAHPS - Consumer Assessment of Healthcare Providers and Systems
This measure provides information on parents’ experience with their child’s Medicaid organization.
Why is this important?
CAHPS surveys show if members are satisfied with their health plan.
Self-Reported Overall Health (Adult and Child)
The percentage of members reporting overall excellent or very good health. This question asks about:
- In general, how would you rate your overall health?
Why is this important?
Self-Reported Overall Health provides valuable feedback on the physical health of the patient population. This information helps healthcare providers and systems develop prevention and treatment strategies that address patients' physical health needs.
Self-Reported Overall Mental or Emotional Health (Adult and Child)
The percentage of members reporting overall excellent or very good mental or emotional health. This question asks about:
- In general, how would you rate your overall mental or emotional health?
Why is this important?
Self-Reported Overall Mental or Emotional Health provides valuable feedback on the mental or emotional health of the patient population. This information helps healthcare providers and systems develop prevention and treatment strategies that address patients' mental and emotional health needs.
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.
Why is this important?
Most Upper Respiratory Infections (URIs) are caused by viruses and require no antibiotic treatment. Increased education and awareness of the appropriate treatment for URIs can reduce the danger of antibiotic-resistant bacteria.
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
The percentage of adults 18–64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription.
Why is this important?
Acute bronchitis almost always get better on its own without antibiotic treatment. Increased education and awareness of the appropriate treatment for acute bronchititis can reduce the danger of antibiotic-resistant bacteria.
Non-Recommended Cervical Cancer Screening in Adolescent Females
The percentage of adolescent females 16–20 years of age who were screened unnecessarily for cervical cancer.
Why is this important?
Cervical Cancer Screening in adolescent females can often produce false-positive results and lead to unnecessary tests and treatment.
Use of Imaging Studies for Low Back Pain
The percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.
Why is this important?
Most people with low back pain improve within the first two weeks. Avoiding imaging for patients when there is no indication of an underlying condition can prevent unnecessary harm and unintended consequences to patients and can reduce health care costs.
Adults’ Access to Preventive/Ambulatory Health Services
The percentage of members age 20 years and older who had an ambulatory or preventive care visit during the measurement year. Three age stratifications and a total rate are reported:
- 20-44 years
- 45-64 years
- 65 years and older
- Total
Why is this important?
Seeing a doctor regularly for checkups and screenings can help you stay healthy.
Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer.
Why is this important?
Women should receive breast cancer screenings as recommended by their doctor for early detection and treatment.
Cervical Cancer Screening
Percentage of women 21–64 years of age who were screened for cervical cancer:
- Women age 21-64 who had cervical cytology performed every 3 years.
- Women age 30-64 who had cervical cytology/HPV co-testing performed every 5 years.
Why is this important?
Women should receive cervical cancer screenings as recommended by their doctor for early detection and treatment.
Colorectal Cancer Screening
The percentage of members 50-75 years of age who had appropriate screening for colorectal cancer.
Why is this important?
Adults should receive colorectal cancer screenings as recommended by their doctor for early detection and treatment.
Flu Vaccinations for Adults Ages 18 to 64
The percentage of adults 18 years of age and older who self-report receiving an influenza vaccine within the measurement period.
Why is this important?
Flu shots can help to prevent flu.
Hepatitis C Virus Screening
Percentage of eligible individuals screened for hepatitis C virus infection.
Why is this important?
Hepatitis C screening can lead to earlier treatment that can prevent progression of liver disease.
Cesarean Rate for Low-Risk First Birth Women
The percentage of cesareans in live births at or beyond 37.0 weeks gestation to women that are having their first delivery and are singleton (no twins or beyond) and are vertex presentation (no breech or transverse positions).
Why is this important?
Avoiding unnecessary C-section deliveries without a medical reason can reduce risks to the mother and baby.
Chlamydia Screening in Women
The percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for Chlamydia during the measurement year.
Why is this important?
Chlamydia screenings are needed to be able to identify it so it can be treated.
Contraceptive Care-All Women (ages 21-44)
The percentage of women ages 21-44 who are at risk of unintended pregnancy and were provided a most or moderately effective method of contraception or were provided a LARC. Two rates are reported.
- Contraceptive Care-All Women (ages 21-44) LARC
- Contraceptive Care-All Women (ages 21-44) Most/Moderate
Why is this important?
Unintended pregnancy is linked to preterm birth and postpartum depression. Use of birth control is critical in preventing unintended pregnancy.
Contraceptive Care-Postpartum (ages 21-44)
The percentage of women ages 21-44 who had a live birth and were provided a most or moderately effective method of contraception within 3 and 60 days of delivery. Four rates are reported.
- Contraceptive Care-Postpartum (ages 21-44) LARC 3 Days
- Contraceptive Care-Postpartum (ages 21-44) LARC 60 Days
- Contraceptive Care-Postpartum (ages 21-44) Most/Moderate 3 Days
- Contraceptive Care-Postpartum (ages 21-44) Most/Moderate 60 Days
Why is this important?
Receiving contraceptives after a pregnancy can help to space out pregnancies.
Percentage of low birth weight births
Percentage of live births that weighted less than 2,500 grams in the state during the reporting period.
Why is this important?
Babies with low birth weight face more risks and health issues.
Prenatal and Postpartum Care - Postpartum Care
The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year that had a postpartum visit on or between 7 and 84 days after delivery.
Why is this important?
It is important for both the mother's health and the baby's health to have checkups during and after the pregnancy.
Prenatal and Postpartum Care - Timeliness of Prenatal Care
The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization.
Why is this important?
It is important for both the mother's health and the baby's health to have checkups during and after the pregnancy.
Coordination of Care
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often did your personal doctor seem informed and up to-date about the care you got from these doctors or other health providers?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Customer Service
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often did your health plan’s customer service give you the information or help you needed?
- In the last 6 months, how often did your health plan’s customer service staff treat you with courtesy and respect?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Getting Care Quickly
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, when you needed care right away, how often did you get care as soon as you needed?
- In the last 6 months, how often did you get an appointment for a check-up or routine care as soon as you needed?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Getting Needed Care Quickly
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often was it easy to get the care, tests, or treatment you needed?
- In the last 6 months, how often did you get an appointment with a specialist as soon as you needed?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
How Well Doctors Communicate
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?
- In the last 6 months, how often did your personal doctor listen carefully to you?
- In the last 6 months, how often did your personal doctor show respect for what you had to say?
- In the last 6 months, how often did your personal doctor spend enough time with you?
The values displayed here represent the percentage of members reporting Never, Sometimes, Usually and Always.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Health Care
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate all your health care in the last 6 months?
The values displayed here represent any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Health Plan
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate your health plan?
The values displayed here represent any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Personal Doctor
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate your personal doctor?
The values displayed here represent any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Rating of Specialist
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask patients to report on and evaluate their experiences with healthcare providers and insurers. This question asks about:
- What number would you use to rate that specialist?
The values displayed here represent any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible.
Why is this important?
Provides valuable real-world consumer feedback to healthcare providers and systems that can be used to better the overall customer experience.
Adolescent Well-Care Visits
The percentage of enrolled members 12-21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
Why is this important?
Seeing a provider regularly for checkups and screenings can help to keep teens healthy.
Adult BMI Assessment
The percentage of members 18-74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement or the year prior to the measurement year.
Why is this important?
Monitoring weight and body mass can tell you whether a person's weight is in a healthy range.
Annual Monitoring for Patients on Persistent Medications
The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. For each product line, report each of the two rates separately and as a total rate.
Why is this important?
People taking certain medications should have regular tests to prevent and diagnose problems.
Asthma Medication Ratio-Total
The percentage of patients 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.
Why is this important?
Using effective medicines for asthma can improve health and quality of life.
Childhood and Adolescents Access to Primary Care Practitioners
Percentage of children ages 12 months – 19 years who had a visit with a PCP. The MCO reports four separate percentages:
- Children 12-24 months and 25 months – 6 years who had a visit with a PCP in the measurement year.
- Children 7-11 years and adolescents 12-19 years who had a visit with a PCP in the measurement year or the year prior to the measurement year.
Why is this important?
Seeing a doctor regularly for checkups and screenings can help to keep children and teens healthy.
Childhood Immunization Status
The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.
- Combo 2 – DTaP, IPV, MMR, HiB, HepB, VZV
Why is this important?
It is recommended that children receive their shots as scheduled to help prevent diseases.
Comprehensive Diabetes Care - Medical attention for nephropathy
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) with medical attention for nephropathy.
Why is this important?
It is important for people with diabetes to have regular checkups to help prevent and diagnose problems like blindness, kidney disease, and heart disease.
Elective Delivery
This measure assesses patients with elective vaginal deliveries or elective cesarean sections at >= 37 and < 39 weeks of gestation completed
Why is this important?
Reducing early deliveries without a medical reason can reduce risks to the baby.
Initiation of Injectable Progesterone for Preterm Birth Prevention
The percentage of women 15-45 years of age with evidence of a previous preterm singleton birth event (24-36 weeks completed gestation) who received one or more progesterone injections between the 16th and 24th week of gestation for deliveries during the measurement year.
Why is this important?
For women who have already had a preterm birth, it is important for them to receive progesterone injections if their doctor recommends them.
Medication Management for People with Asthma
The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on during the treatment period. Two rates are reported.
Why is this important?
Using effective medicines for asthma can improve health and quality of life.
Well-Child Visits in the First 15 Months of Life - Six or More Well Child Visits
The percentage of members who turned 15 months old during the measurement year and who had six or more well-child visits with a PCP during their first 15 months of life.
Why is this important?
Seeing a provider regularly for checkups and screenings can help to keep infants healthy.
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
The percentage of members 3-6 years of age who had one or more well-child visits with a PCP during the measurement year.
Why is this important?
Seeing a provider regularly for checkups and screenings can help to keep children healthy.
About the Medicaid Managed Care Quality Dashboard
Quality Improvement, Population Health and Health Equity Section
The purpose of the Medicaid Quality Dashboard is to provide transparency and
accountability in the healthcare provided to Medicaid members.
Medicaid regularly monitors the performance of contracted managed care organizations (MCOs)
on a wide range of quality measures, including both HEDIS and non-HEDIS metrics. (Please note that this dashboard only applies to the managed care program and does not include Medicaid fee-for-service members.)
The panel to your left shows groupings of quality measures. For each quality measure, results are reported for the most recent year, by plan and statewide, along with trend information since measurement year 2015.
Trend information is not always available for all measures.
The metrics on this dashboard are displayed according to the measurement year.
Therefore, the MY 2021 quality measure results reflect care that happened in calendar year 2021.
In addition, where available, a dashed line shows baseline data from prior to implementation of the managed care program.
The baseline data is from the 2011 measurement year and reflects care that happened in 2011.