HEDIS®
Molina Complete Care (MCC) Plan contracts with the Arizona Health Care Cost Containment System (AHCCCS) and reports the required quality and performance measure metrics to certify members are receiving high quality of care. The metrics are identified by AHCCCS and associated with specifications, from the Health Effectiveness Data and Information Set (HEDIS) and the Centers for Medicare & Medicaid Services (CMS) Core Set. MCC continuously monitors our results to measure the rate our members are obtaining preventive health services, such as child and adolescent immunizations, well child visits to their PCP and Dentist, breast and cervical cancer screening, and more. Monitoring and reporting this data allow MCC to identify areas for improvement and implement interventions to increase the use of preventive services.
HEDIS®
Molina Complete Care (MCC) uses the Healthcare Effectiveness Data and Information Set (HEDIS®) tool every year for quality reporting. This is done by looking at the type of care and services provided. Along with more than 90% of American health plans, MCC uses HEDIS® results to track quality performance from year to year and to identify opportunities for improvement. During the first two quarters of each year, provider offices may be contacted to submit specific medical records for review, an integral part of the HEDIS® data collection process. HEDIS® data collection is in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- 2022 HEDIS® (MEASUREMENT YEAR) MEDICAID REFERENCE SHEET
- Annual Dental Visits
- Antidepressant Medication Management
- Metabolic Monitoring for Children and Adolescents on Antipsychotics
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
- Breast Cancer Screening
- Childhood Immunization Status
- Follow-Up After Emergency Department Visit for Substance Use
- Follow-Up After Emergency Department Visit for Mental Illness
- Hemoglobin A1c Control for Patients With Diabetes
- Use of Opioids at High Dosage
- Initiation and Engagement of Substance Use Disorder Treatment
- Immunizations for Adolescents
- Plan All-Cause Readmissions
- Postpartum Care
- Timeliness of Prenatal Care
- Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who are Using Antipsychotic Medications
- Well-Child Visits in the First 30 Months of Life
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
Detailed results can be found by clicking the links below:
HEDIS® Annual Trends
If you have any questions, would like additional information about HEDIS®, or have suggestions for our quality improvement program, please contact MCC.
* Printed copies of information posted on our website are available upon request.
HEDIS® is a Registered Trademark of the National Committee for Quality Assurance.
CMS Core
The Center for Medicaid and CHIP Services (CMCS) developed a set of core measures reflective of an overall quality strategy. The quality strategy for improving health outcomes are the founding principles in which MCC operates our quality improvement programs.
https://www.medicaid.gov/medicaid/quality-of-care/index.html
Quality Improvement Contacts
The Quality Improvement Department is here to help! Feel free to reach out with questions or to request a technical assistance or QI meeting. Our quality improvement and performance measure specialists can be reached at MCCAZHEDIS@MolinaHealthCare.com.