Gundersen Lutheran Health Plan is dedicated to providing safe, effective, and efficient services. One way we monitor the quality of our health plan services is through voluntary participation in a program that collects and reports health plan performance data. This program is called HEDIS (Healthcare Effectiveness Data and Information Set). In the United States, more than 90 percent of health insurance plans participate in HEDIS data collection. Some consumers use HEDIS data to compare health plans and guide their annual coverage selection.
HEDIS includes more than 70 standardized measures that monitor how well health plans perform on key health care issues. These measures address many areas of care—from how many patients receive beta-blocker medicines after a heart attack to how many children and teens receive the shots they need to stay well. HEDIS performance measures are continually updated and new measures are added as medical standards evolve.
What our Gundersen Lutheran Health Plan Commercial HMO HEDIS 2011 results show
Based on HEDIS 2011, Gundersen Lutheran Health Plan’s Commercial HMO performs above the 90th percentile for many measures such as:
- Childhood immunization status (Combination 2) - The percentage members who have received the following vaccines by their second birthdate - at least four DTaP (diptheria, tetanus, pertussis), at least three IPV (inactivated polio virus), at least one MMR (measles, mumps and rubells), at least three Hib (haemophilus influenza type B), and at least one VZV/chicken pox vaccine.
- Breast cancer screening - The percentage of women 40 to 69 years of age who had a mammogram to screen for breast cancer in 2010 or 2011.
- Colorectal cancer screening - The percentage of members 50–75 years of age who had appropriate screening for colorectal cancer.
- Controlling high blood pressure - The percentage of members 18–85 years of age who had a diagnosis of hypertension (high blood pressure) and whose blood pressure was controlled (less than 140/90) during 2011.
In addition, we are working to improve several measures including:
- Antidepressant medication management - The percentage of members who are diagnosed with depression and stay on an antidepressant medication for at least 12 weeks and at least 6 months.
- Cholesterol management for patients with cardiovascular disease - The percentage of members with cardiovascular disease who have had cholesterol - LDL screening in 2011 – and who had an LDL level of less than 100.
What our Gundersen Lutheran Health Plan Senior Preferred HMO HEDIS 2011 results show
Based on HEDIS 2011, Gundersen Lutheran Health Plan’s Senior Preferred HMO performs above the 90th percentile for many measures such as:
- Breast cancer screening - The percentage of women 40 to 69 years of age who had a mammogram to screen for breast cancer in 2010 or 2011.
- Colorectal cancer screening - The percentage of members 50–75 years of age who had appropriate screening for colorectal cancer.
- Controlling high blood pressure - The percentage of members 18–85 years of age who had a diagnosis of hypertension (high blood pressure) and whose blood pressure was controlled (less than 140/90) during 2011.
In addition, we are working to improve several measures including:
- Antidepressant medication management - The percentage of members who are diagnosed with depression and stay on an antidepressant medication for at least 12 weeks and at least 6 months.
- Osteoporosis management in women who had a fracture - The percentage of women 67 years of age and older who suffered a fracture and who had either a bone mineral density test or prescription for a drug to treat or prevent osteoporosis in the six months after the fracture.
For a more detailed overview of all quality measures or for a copy of our program evaluation or description, please contact Gundersen Lutheran Health Plan Quality Management at (800) 897-1923.
The source for data contained in this article is Quality Compass 2011. Quality Compass and HEDIS are registered trademarks of the National Committee for Quality Assurance.