Health Plan Quality of Care Report for Utah Commercial HMOs, Medicaid & CHIP Health Plans (HEDIS)


The quality of care measures presented in this report come from the Healthcare Effectiveness Data and Information Set (HEDIS), which is developed and maintained by the National Committee for Quality Assurance (NCQA). The 2018 HEDIS measurement set contain 88 measures across seven major areas of care. Health plans nationwide collect these measures to see how they performed in different areas of health care over the previous year. Each year, eligible Utah health plans report HEDIS measures to the Utah Department of Health and a subset of those measures is included in this report. Measures in this report are based on information from patient visits in 2017. All data are reviewed by NCQA-certified auditors to ensure that the reported HEDIS measures are representative and accurate. The National Committee for Quality Assurance (NCQA) is a non-profit organization committed to assessing, reporting on and improving the quality of care provided by the nation´s health plans. To find out more, please see the NCQA website.


For some HEDIS measures, health plans can choose one of two ways to collect their data. If a plan chooses the administrative method, the data are collected from the health plan's claims database to identify cases and compute the HEDIS measures. If a health plan uses the hybrid method, cases are first identified using the claims database, then a registered nurse does reviews of medical charts to find additional information about the HEDIS measure. In the tables that follow, measures collected using the administrative method are labeled "Administrative" and measures collected using the hybrid method are labeled "Admin+Chart Review". The hybrid method takes longer and costs more, but the reported values for HEDIS measures are usually more accurate than when health plans use the administrative method. Therefore, differences between reported rates may be because the plans differ in quality or because the plans collected data using different methods. Whenever possible, comparisons should only be made between health plans that used the same data collection method for a given measure. In general, administrative rates will be lower than hybrid rates.


Some variables have a "Not Reported" or a "Not Applicable" designation. "Not Reported" means that the health plan chose not to report a rate for that measure. This could be because there were significant problems with the data. A "Not Applicable" rate means that the sample size for that measure was too small (less than 30) to calculate a valid rate. All "Not Reported" and "Not Applicable" designations are governed by NCQA reporting rules, and do not reflect the overall quality of care.