HEDIS Changes

Each year, Humana uses claims and encounter data and medical records documentation to gather information for the Health Plan Employer Data and Information Set (HEDIS^®). HEDIS, the most widely used set of performance measures in the managed care industry, helps Humana assess its performance in meeting clinical care guidelines and satisfying members’ needs.

The 2006 HEDIS review will reflect some changes in effectiveness of care measures:

• Timing requirements for vaccines: The pediatric immunization schedule should now include administration of the pneumococcal conjugate vaccine Prevnar^®, in addition to the OPV/IPV, MMR, Hepatitis B, HIB and Varicella vaccines. The Prevnar vaccine should be administered at 2, 4, 6 and 12 to 15 months of age; infants should receive all four doses.
• Breast cancer screening: Breast cancer screening practices will no longer be
  part of the medical record review; this screening will now rely on administrative data only.
• Diabetic retinopathy telescreening: The HEDIS measure for diabetic retinopathy screening now recognizes the use of digital retinal cameras as a screening option. Diabetic retinopathy screening should be done each year.

If you would like to receive an annual progress report of how your market’s quality improvement goals are being met, mail a request to:

Lynn Lee
Humana
Progress Report
201 West Main, RVS 2
Louisville, KY 40202

Clinical care staff should be made aware of these changes for the coming year. These efforts will help make the 2006 HEDIS review a quicker and more positive experience.

For more information about HEDIS performance measures, visit www.ncqa.org/Programs/HEDIS/.

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