|
Page Updated 4/25/2002
(M)
HEDIS MEASURES
|
Health Plan Employer Data and Information Set (HEDIS) is a set of
standardized performance measures designed to ensure that
purchasers and consumers have the information they need to
reliably compare the performance of managed health care plans. The
performance measures in HEDIS are related to many significant
public health issues such as cancer, heart disease, smoking, asthma
and diabetes.
For
more information on HEDIS statistics.
HEDIS is sponsored, supported and
maintained by NCQA.
|
| |
| NCQA
Releases State of Managed Care Quality 2000 Report |
The
National Committee for Quality Assurance (NCQA) released its
fourth annual State of Managed Care Quality report, which contains
encouraging news for health care consumers. Across every single
clinical quality measure NCQA examines, and in every region of the
country, reporting plans made their largest gains ever in 1999.
The report is based on an analysis of health plan performance data
from Quality Compass® 2000, NCQA’s database of
managed care information, and the most comprehensive resource of
its kind. The 466 health plan products submitting data to the 2000
edition of Quality Compass cover some 51 million people.
NCQA
2001 Report 
|
|
Welcome to Diabetes Statistics:
 Statistics
and data are valuable tools to help prove that the
work you are doing impacts upon patient care. Please
use this section to access statistics, data sources, and
analytical tools to improve your ability to report on the
statistical impact of your health care services for chronic
disease management.
 The
Massachusetts Division of Health
Care Finance and Policy collects, analyzes, and disseminates information
with the goal of improving the quality, efficiency, and effectiveness of the
health care delivery system in MA.
One approach to assessing our health care delivery system is to
look at health care outputs or outcomes. Traditional outcome
measures include mortality and morbidity rates. Another
outcome measure is "preventable hospitalization" (PH)
rates. Because lack of primary care for particular medical
conditions often leads to hospitalization, it is possible to
measure preventable hospitalization rates as a way of assessing
primary care delivery, thereby identifying appropriate areas to
improve in the health care delivery system. Certain ambulatory
care sensitive conditions such as diabetes, if treated in a timely
fashion with adequate primary care and managed properly on an
outpatient basis, should not advance to the point where
hospitalization is required. Preventable
hospitalization is the term used by the Division to describe
inpatient hospital admissions for ambulatory care sensitive
conditions.
Information and data on preventable hospitalization is designed to
serve as a tool for improving the health status of Massachusetts
residents. It is also a tool for containing costs.
This tool promotes the efficient use of health care resources
primarily because encouraging appropriate delivery of primary care
reduces the need for costly inpatient care.
The statistical tables, courtesy of the Division
of Health Care Finance & Policy, listed below are based on FY
1999 Preventable Hospitalizations (PH) per 1,000 population for diabetes
in the categories of geographic area, age breakdown, and payor source. The addition of a payor source code allows
for comparisons in performance among insurance plans and other Health
Maintenance Organizations (HMO).
|
Links to Other State and Federal Statistics are Listed Below the Division of Heath Care Finance & Policy
Data Tables.
|
|
Massachusetts
Division of Health Care Finance & Policy
Preventable Hospitalizations - FY 99 |
|
|
|
Diabetes Preventable Hospitalizations (PH)
Massachusetts Residents (ZIP Code 01001 - 02791)
FY 99, All Ages |
|
FY 1999 Diabetes, All Ages
|
|
Top 10
|
ZIP Code
|
City / Town
|
Counts
|
|
1
|
02124
|
Dorchester South
|
91
|
|
2
|
02301*
|
Brockton
|
79
|
|
3
|
02119
|
Roxbury
|
74
|
|
4
|
02740
|
New Bedford
|
72
|
|
5
|
02169
|
Quincy
|
68
|
|
6
|
02148
|
Malden
|
61
|
|
7
|
01040
|
Holyoke
|
57
|
|
8
|
01109
|
Springfield
|
52
|
|
9
|
01201
|
Pittsfield
|
51
|
|
10
|
02780
|
Taunton
|
50
|
|
Statewide
|
4,963
|
|
Per US Postal Service,
this is a new Zip Code as of 7/1/98.
It was 02401
|
|
Massachusetts Residents
(ZIP Codes 01001 - 02791)
Preventable Hospitalizations (PH)
FY 1999 - Age Breakdown
|
|
Ages
0 - 17
|
|
Ages
18 - 64
|
|
Condition
|
Counts
|
Population¹
|
PH
Rate²
|
|
Condition
|
Counts
|
Population
|
PH
Rate
|
|
Diabetes
|
428
|
1,419,512
|
0.30
|
|
Diabetes
|
2,619
|
3,865,974
|
0.68
|
|
Ages
65+
|
|
All
Ages
|
|
Condition
|
Counts
|
Population
|
PH
Rate
|
|
Condition
|
Counts
|
Population
|
PH
Rate
|
|
Diabetes
|
1,916
|
883,647
|
2.17
|
|
Diabetes
|
4,963
|
6,169,133
|
0.80
|
|
¹ -Population
figures are from Claritas, Inc.
² - ph rates are per one thousand population.
PH rate = counts/pop x 1,000 |
|
Massachusetts Residents
(Zip Codes 01001 - 02791)
Asthma & Diabetes Preventable Hospitalizations
Observation Stay Discharges
FY 1998, All Ages* |
|
FY 1998, PH
Observation Stays, All Ages |
Counts |
% |
| Asthma |
3,611 |
18.37% |
| Diabetes |
852 |
4.33% |
| Other
PH Conditions (22) |
15,192 |
77.29% |
|
Statewide |
19,655 |
100.00% |
|
Observation
Stay Discharge data for FY99 to be released in early
spring |
|
Massachusetts Residents Zip Codes (01001
- 02791)
Diabetes Preventable Hospitalizations
FY 1999 - Age Breakdown/Payor Source |
| Diabetes,
Ages 0 - 17 |
| Payor
Type |
Counts |
% |
| HMO |
151 |
35.28% |
| Medicaid
non-Managed Care |
59 |
13.79% |
| Blue
Cross Managed Care |
59 |
13.79% |
| Medicaid
Managed Care |
38 |
8.88% |
| Commercial
non-Managed Care |
34 |
7.94% |
| Blue
Cross non-Managed Care |
28 |
6.54% |
| PPO
and other Managed Care Plan |
26 |
6.07% |
| Not
Valid Code |
14 |
3.27% |
| Free
Care |
9 |
2.10% |
| Others* |
10 |
2.34% |
| All
Payor Types |
428 |
100.00% |
|
|
|
|
|
Diabetes,
Ages 18 - 64 |
| Payor
Type |
Counts |
% |
| HMO |
558 |
21.31% |
| Medicare
non-Managed Care |
500 |
19.09% |
| Medicaid
non-Managed Care |
400 |
15.27% |
| Blue
Cross Managed Care |
163 |
6.22% |
| Self-Pay |
158 |
6.03% |
| Commercial
non-Managed Care |
152 |
5.80% |
| Medicaid
Managed Care |
144 |
5.50% |
| Blue
Cross non-Managed Care |
137 |
4.51% |
| Free
Care |
118 |
5.07% |
| PPO
and other Managed care Plan |
101 |
3.86% |
| Not
Valid Code |
71 |
2.71% |
| Medicare
Managed Care |
44 |
1.68% |
| Commercial
Managed Care |
40 |
1.53% |
| Other
Government Payor |
15 |
0.57% |
| Other
non-Managed Care Plan |
14 |
0.53% |
| Others* |
4 |
0.15% |
| TOTAL |
2,619 |
100.00% |
| |
|
|
| Diabetes,
Ages 65 + |
| Payor
Type |
Counts |
% |
|
Medicare non-Managed Care |
1,409 |
73.54% |
| Medicare
Managed Care |
270 |
14.09% |
| HMO |
70 |
3.65% |
|
Not Valid Code |
62 |
3.24% |
| Commercial
non-Managed Care |
23 |
1.20% |
| Blue
Cross
non-Managed Care |
20 |
1.04% |
| Medicaid
non-Managed Care |
14 |
0.73% |
| Free
Care |
14 |
0.73% |
| Self-Pay |
12 |
0.63% |
| PPO
and other Managed Care Plan |
11 |
0.57% |
| Blue
Cross Managed Care |
6 |
0.31% |
| Others* |
5 |
0.26% |
|
All Payor Types |
1,916 |
100.00%
|
|
|
|
Diabetes, All
Ages |
|
Payor Type |
Counts |
% |
|
Medicare non-Managed Care |
1,909 |
38.46% |
|
HMO |
779 |
15.70% |
|
Medicaid non-Managed Care |
473 |
9.53% |
|
Medicare Managed Care |
314 |
6.33% |
|
Blue Cross Managed Care |
253 |
4.59% |
|
Commercial non-Managed Care |
209 |
4.21% |
|
Blue Cross non-Managed Care |
185 |
3.73% |
|
Medicaid Managed Care |
182 |
3.67% |
|
Self Pay |
175 |
3.53% |
|
Free Care |
141 |
2.84% |
|
PPO and other Managed Care Plan |
138 |
2.78% |
|
Not Valid Code |
147 |
2.96% |
|
Commercial Managed Care |
47 |
0.95% |
|
Other non-Managed Care Plan |
16 |
0.32% |
|
Other Government Payor |
16 |
0.32% |
|
Others* |
5 |
0.11% |
|
All Payor Types |
4,963 |
100.00% |
|
*
For patient confidentiality, others are the sum of payor
types with
less
than six discharges. |
Links to Other Diabetes-Related
Statistics
- The
Burden of Diabetes in Massachusetts, 1993-1995
This report
summarizes the burden of diabetes in Massachusetts between 1993 and 1995. It draws on a variety
of data sources that are regularly collected at the state
and federal level, and which comprise the Massachusetts
Diabetes Control Program’s surveillance system. The
report addresses the prevalence of diabetes, its associated
morbidities, and the cost of health care spent on
hospitalizations related to the disease.
|
-
Diabetes
in Massachusetts: Results from the Behavioral Risk Factor Surveillance System,
1994-1996 (BRFSS)
The BRFSS is a statewide
random telephone survey of MA 18+ adults conducted annually since 1986 as part of a
cooperative agreement between the national Centers for
Disease Control and Prevention and the MA Department of Public Health. BRFSS collects information about a wide variety of
health issues, ranging from health-related behavior and
access to medical care to opinions on health and health policy
issues. This information helps identify the need for health
interventions, monitor effectiveness of prevention and
intervention programs, develop health policy and
legislation, and measure progress toward attaining state and
national health objectives. The MA Diabetes Control
Program uses this information to monitor the burden of diabetes
in Massachusetts.
|
- Mass
Community Health Information Profile (MassCHIP)
The Massachusetts Community
Health Information Profile (MassCHIP) is a dynamic,
user-friendly information service that provides free, online
access to these and many other health and social indicators.
With MassCHIP, you can obtain community-level data to assess
health needs, monitor health status indicators, and evaluate
health programs.
|
-
Massachusetts
Health Data Consortium, Inc
The Massachusetts Health Data Consortium
was founded in 1978 by the state's major public and private
health care organizations. They recognized the need for a
neutral agency, an "honest broker," independent of
special interests, to collect, analyze and disseminate health
care information. The Consortium's information products,
services and special projects support health policy development,
technology planning and implementation, and improved decision
making in the allocation and financing of health care.
|
- New
England HEDIS Coalition
The New England HEDIS Coalition (NEHC) was established in 1993
as a collaborative effort among health plans and purchasers to
implement collection and reporting of HEDISR
(Health Plan and Employer Information Set) performance measures.
HEDIS captures comprehensive data and evaluates the actual
results a health plan achieves, in effectiveness of care, access
and availability of care, cost of care and member satisfaction.
With each revision, HEDIS addresses a wider range of health care
issues and becomes more "outcomes," or
"results," oriented. NCQA requires that HEDIS measures
are (1) relevant to purchasers and consumers, (2) scientifically
sound and (3) feasible to produce at a reasonable cost and in a
consistent fashion with all regard for patient confidentiality.
HEDIS Health
Plan Performance Charts in New England
|
-
National
Committee on Quality Assurance (NCQA)
NCQA is an independent, non-profit organization whose mission is
to evaluate and report on the quality of the nation’s managed
care organizations. Their web site is a key part of that effort.
It allows them to provide you and millions of other visitors
with information you can use to help decide which health plan
you want to cover you, your family, or your employees.
NCQA's 2001
State of Managed Care Quality Report
|
|
![MCDIN Logo [Home]](../images/mcdin_A.gif){kind=small}
![MCDIN Logo [Home]](../images/mcdin_B.gif)
