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HEDIS - Q4 Targeted Measures

COVID-19 continues to impact our members and providers. We are seeing significant declines in the number of members who are making preventative care appointments with their PCPs.  We need your help to close all 2020 gaps in care. Please review your patient records and contact Buckeye members who have missed appointments – particularly those who are not compliant on HEDIS-related measures. Buckeye is here to help. Remind them we offer:

  • Transportation to and from provider offices for well-care and treatment; and trips to the pharmacy for medications.
  • No-cost telehealth visits for patients who may have transportation or health related barriers to making an in-person visit.

Your Buckeye provider representative is here to help you identify ways to reach members and close care gaps. If you are unsure who your representative is, please contact Provider Services at 866-296-8731.

Targeted HEDIS measures for Q4 2020. 

  • Breast Cancer Screening
  • Cervical Cancer Screening
  • Post-Partum Care
  • Adult Access
  • Child Access
  • Immunizations
  • Annual Dental Visit
  • Comprehensive Diabetes Care:  HbA1c (Poor Control, Testing), Eye Exams, Blood Pressure
  • APM, SMC, SMD, SDD
  • COA, COL, PCR, MDS

We value our partnership and thank you for your continued support.

Q4 2020 HEDIS Measurement Descriptions

(AAP) Adult Access: Members 20 years and older who had an ambulatory or preventive care visit during the measurement year.

(ADV) Annual Dental Visit:  Members 2–20 years of age who had at least one dental visit during the calendar year with a Dental Practitioner.

(APM) Metabolic Monitoring for Children or Adolescents on Antipsychotics: Children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing (blood glucose or A1C and LDL-C or cholesterol test).

(BCS) Breast Cancer Screening:  Women 50–74 years of age who had one or more mammograms between: October 1 two years prior to the measurement year and December 31 of the measurement year.

(CCS) Cervical Cancer Screening:  Women 21–64 years of age who were screened for cervical cancer using either of the following criteria:

  • Women age 21–64 who had cervical cytology performed during the measurement year or the two years prior (every 3 years).
  • Women age 30–64 who had cervical cytology/human papillomavirus (HPV) co-testing performed during the measurement year or the four years prior (every 5 years).

(CDC) Comprehensive Diabetes Care: Members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following during the measurement year:

  • Hemoglobin A1c (HbA1c) testing
  • Medical attention for nephropathy
  • Hemoglobin A1c poor control (>9%)
  • BP control (<140/90 mm Hg)
  • Eye exam (retinal) performed

(CIS) Childhood Immunization Status:  Children who complete immunizations on or before child’s 2nd birthday and document preferably on an Immunization Record/Flow sheet:

  • DTap: 4 dose     
  • PCV: 4 dose       
  • RV: 2 dose or 3 dose series
  • IPV: 3 dose        
  • MMR: 1 dose    
  • Flu (LAIV): 2 dose
  • HepB: 3 dose    
  • VZV: 1 dose       
  • HIB: 3 dose        
  • HepA: 1 dose    

(COA) Care of Older Adults:  The percentage of adults 66 years and older who had each of the following during the measurement year:

  • Advance Care Planning
  • Medication Review
  • Functional status assessment
  • Pain Assessment

(COL) Colorectal Cancer Screening:  Members 50–75 years of age who have had appropriate screening for colorectal cancer.

(IMA) Immunizations for Adolescents:  Adolescents who complete immunizations on or before members’ 13th birthday and document preferably on an Immunization Record/Flow sheet:

  • Meningococcal conjugate vaccine (serogroup A, C, W and Y): 1 dose
  • Tdap (tetanus, diphtheria toxoids and acellular pertussis): 1 dose

(PPC) Postpartum Care:  The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.

(SMC) Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia: Members 18–64 years of age with schizophrenia or schizoaffective disorder and cardiovascular disease who had an LDL-C test during the measurement year. Members who have cardiovascular disease are defined as having any of the following during the year prior to the measurement year:

  • Discharged from an inpatient setting with an Acute Myocardial Infarction (AMI) diagnosis on the discharge claim.
  • Coronary Artery Bypass Graft (CABG) in outpatient or inpatient setting.
  • A Percutaneous Coronary Intervention (PCI) in outpatient or inpatient setting.
  • Diagnosed with Ischemic Vascular Disease (IVD) during both the measurement year and the year prior to measurement year.

(SMD) Diabetes Monitoring for People with Diabetes and Schizophrenia:  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.

(SSD) Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are Using Antipsychotic Medications:  The percentage of members 18 – 64 years of age with schizophrenia, schizoaffective disorder or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.