TriWest Uses HEDIS Measurements

TriWest utilizes the Healthcare Effectiveness Data and Information Set (HEDIS) effectiveness of care measures, a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service. With HEDIS-like measures, TriWest monitors effectiveness of care, specific to the TRICARE population, for a broad range of important health issues, including the following:

• Breast Cancer Screening
• Measure: Percent of women between 40-64 years old who had at least one mammogram in the past two years
• Cholesterol Management for patients with cardiovascular conditions
• Measure: Percent of members 18-64 years of age who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), percutaneous translumina coronary angioplasty (PTCA); or who had a diagnosis of ischemic vascular disease (IVD) who received an LDL-C screening and whose LDL-C level was controlled to <100mg/dL.
• Comprehensive Diabetes Care
• Measures: Percentage of members 18-64 years of age with diabetes (type 1 and type 2) who had each of the following:
• Hemoglobin A1c (HbA1c) testing
• Poorly controlled HbA1c (greater than 9.0)
• Good HbA1c control (level less than 7.0)
• Eye exam (retinal) performed
• Serum cholesterol level (LDL-C) screening
• Cholesterol level (LDL-C) controlled to less than 100 mg/dL
• Medical attention for kidney disease (nephropathy)
• Blood Pressure control (<130/80 mm Hg)
• Blood Pressure control (<140/90 mm Hg)
• Persistence of Beta-Blocker Treatment After a Heart Attack
• Measure: Percentage of members 35-64 years of age hospitalized and discharged after surviving a heart attack who received persistent beta-blocker treatment for six months after discharge.
• Use of appropriate Medications for People with Asthma
• Measure: Percentage of enrolled members 5-56 years with persistent asthma who were prescribed medications acceptable as primary therapy for long-term control of asthma.

Your assistance in ensuring that your TRICARE beneficiaries receive appropriate clinical preventive services as well as ongoing management of conditions such as high cholesterol, diabetes, asthma, and treatment after a heart attack is greatly appreciated. 

For further information, please refer to Section 5 of the Provider Handbook regarding Clinical Preventive Services at www.triwest.com/provider in the Resource Library or to the National Committee for Quality Assurance (NCQA) Web site at www.ncqa.org.

Published Date: 03/27/2008