NY Manual
SHP Manual

New York Provider Manual
XVI HEDIS/QARR Quick Reference Guide
Appendix XVIII – Quality Rating Measures
QUALITY RATING MEASURES
PHSP
Medicare
HEDIS MEASURES
 
 
Access and Preventive Care
 
 
Adolescent Well-Care Visit
X
 
Annual Dental Visit – (2–21yrs)
X
 
Breast Cancer Screening
X
X
Care of Older Adults: Functional Status Assessment
 
X
Care of Older Adults: Medication Review
 
X
Care of Older Adults: Pain Screening
 
X
Cervical Cancer Screening
X
 
Childhood Immunizations – Combo 3
X
 
Chlamydia Screening – (16–24 yrs.)
X
 
Colorectal Cancer Screening
X
X
Immunizations for Adolescents
X
 
Postpartum Care
X
 
Well-Child Visit – 3 to 6 yrs.
X
 
Well-Child Visit: up to 15 months (5+ Visits)
X
 
Chronic Care Management
 
 
Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
X
 
Diabetes Care: Eye Exam
X
X
Diabetes Care: Hemoglobin A1c (HbA1c) Testing
X
X
Diabetes Care: Nephropathy
X
X
HIV Comprehensive Care: Engaged in Care 
X
 
HIV Comprehensive Care: Syphilis Screening
X
 
HIV Comprehensive Care: Viral Load Monitoring
X
 
Medication Management for People with Asthma 75% (5-64 yrs.)
X
 
Osteoporosis Management in Women Who Had Fracture
 
X
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
X
 
Acute Care Management
 
 
Appropriate Testing for Children with Pharyngitis
X
 
Avoidance of Antibiotic Treatment with Acute Bronchitis
X
 
AVOIDING ADMISSIONS AND READMISSIONS
 
 
All-Cause Readmission
 
X
Potentially Preventable Readmissions
X
 
PQI: Adult Composite
X
 
PQI: Pediatric Composite
X
 
MEDICATION ADHERENCE AND USE MEASURES
 
 
Medication Adherence for Cholesterol
 
X
Medication Adherence for Hypertension
 
X
Medication Adherence for Oral Diabetes Medications
 
X
Use of High-Risk Medication
 
X
ENROLLEE SATISFACTION MEASURES
 
 
Access to Care and Appointment Availability Audits
X
X
<15 Minutes in Waiting Room – PCP or Specialist
X
X
Getting Care As Needed
X
X
Helpfulness of Office Staff
X
X
Overall Rating of Care Received from PCP
X
X
PCP Discussed Prescription Drugs
 
X
Timely Follow-Up on Test Results
 
X
ENROLLEE HEALTH RISK ASSESSMENT MEASURES
 
 
Annual Flu Vaccine
 
X
Monitoring Physical Activity
 
X
Reducing the Risk of Falling
 
X
Timely Risk Assessment for SNP Members 
 
X