Exhibit Q - Health Plan Employer Data and Information Set (HEDIS).pdf

1. EXCEPTIONAL: Performance meets contractual requirements and exceeds many to the Government’s benefit. The overall contractual performance for the individual measure being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. Rating Range: Contractor exceeds the 75th Percentile standard in all measures at all DMISs and contractor exceeds the 90th Percentile standards for 9 out of 12 measures for all DMISs.

2. VERY GOOD: Performance meets contractual requirements and exceeds some to the Government’s benefit. The overall contractual performance for the individual measure being assessed was accomplished with few minor problems for which corrective actions take by the contractor were highly effective. Rating Range: Contractor exceeds the 75th Percentile standard in all measures at each DMIS and contractor exceeds the 90th Percentile standards for 6 out of 12 measures at all DMISs.

3. SATISFACTORY: Performance meets contractual requirements. The contractual performance was satisfactory for the individual measure being assessed with some minor problems for which corrective actions taken by the contractor were acceptable. Rating Range: Contractor meets the 75th percentile standard in all measures at each DMIS.

4. MARGINAL: Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. Rating Range: Contractor clinics with individual DMISs do not all meet the75th

Percentile standard for all measures.

5. UNSATISFACTORY: Performance does not meet most of the contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problems for which the contractor’s corrective actions appear or were ineffective. Rating Range:

Contractor fails to meet the 75th Percentile standard for less than 6 measures at each DMIS.

SURVEILLANCE METHODOLOGY AND DATA SOURCE: The data source for compliance with this metric is the Performance Based Adjustment Model (PBAM), the Command Management System (CMS) as well as the MHS Portals (Population Health Portal, MHS HEDIS Dashboard, DHA Review & Analysis (R&A) Dashboard). The standards for performance are taken from the NCQA database for each HEDIS measure and establishing where MHS facilities fall by percentile compared to all civilian facilities reporting their data for each measure. This data will be pulled and provided to the contractor monthly.

The 75th and 90th percentile for any given measure may be adjusted on an annual basis. If that occurs the contractor will continue to be assessed on the old percentiles for a period of 6 months at which time they will assessed on the new standards. If the Government elects to change which measures are tracked the contractor will be provide a period of 6 months to come into compliance for any new measures.

EXHIBIT Q – HEALTH PLAN EMPLOYER DATA AND INFORMATION SET

(HEDIS) METRICS

Objective 1: Evidence Based Practice

The medical treatment facilities (MTF) that are a part of Alexander T. Augusta Military Medical Center monitor compliance with national Quality benchmarks. These metrics are consistent with guidance from the Defense Health Agency and apply to MTFs throughout the Military Health System. The contractor will be assessed for compliance with the same metrics as the rest of the ATAMMC MTFs using the below methodology.

If the contractor sets up a clinic which meets the DoD requirements for an individual child DMIS, the MHS Population Health Portal will identify which patients in the enrolled population fit into each metric’s population. It is possible that a single enrollee will fit into the population monitored for more than one metric (e.g., a 52 year old woman would fall into the population monitored for Cervical Cancer Screening as well as Colorectal Screening).

The targets for each metric will be updated annually in accordance with DHA guidance.

Performance Ratings/Ranges:

Methodology:

HEDIS is currently measures the following:

Measure Metric 75th

Percentile 90th

Percentile

1. Antidepressant Medications - Acute

Percentage of members age 18 years and older with major depression who remained on a newly prescribed antidepressant medication for at least 84 days (12 weeks). 78.92% 82.75%

2. Antidepressant Medications - Continuation

Percentage of newly treated members age 18 years and older with major depression who remained on antidepressant medication for at least 180 days (6 months). 62.76% 66.34%

3. Breast Cancer Screening

Percentage of women age 52-74 years of age who had a screening mammogram in the previous 27 months. 75.47% 78.38%

4. Cervical Cancer Screening

Percentage of women age 21-64 with cervical cancer screening within last 36 months or who had cervical cancer screening and human papillomavirus co-testing in the past 5 years, where the woman was age 30 or older at the time of the co-test. 78.36% 81.67%

5. Chlamydia Screening Total

Percentage of sexually active women, ages 16-24, who had a chlamydia screening in the past 12 months. Age stratified 54.43% 64.26%

6. Appropriate Testing for Pharyngitis (Total)

Percentage of members 3 years and older diagnosed with pharyngitis and dispensed an antibiotic, and also received a group A streptococcus (strep) test for the episode. Age stratified 73.07% 79.43%

7. Appropriate Treatment for Upper Respiratory Infection (Total)

Percentage of members 3 months of age and older with a diagnosis of URI and were not dispensed an antibiotic prescription for that episode of care. Age stratified 92.98% 95.65%

8. Colorectal Screening Percentage of adults age 51-75 years who had appropriate colorectal cancer screening. Screening intervals vary according to the method of screening. 69.92% 74.74%

9. Diabetes A1C Testing Percent of members age 18–75 years with diabetes, types 1 & 2, with at least one HbA1C test performed in past 12 months. 92.94% 94.38%

10. Low Back Pain Imaging

Percent of adults age 18-64 with a primary diagnosis of low back pain who did not have an imaging study within 28 days of the diagnosis 82.26% 85.45%

11. Mental Health Follow- Up 7 days

Percent of enrolled patients who received follow-up within 7 days of discharge 54.95% 62.86%

12. Mental Health Follow-Up 30 days

Percent of enrolled patients who received follow-up within 30 days of discharge 76.57% 82.45%

13. Well Child Visits ≥6 visits by age 15 months

Percentage of 15 month enrollees who had at least 6 well child visits. 85.60% 89.14%

14. Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis

Total Percentage of members ages 3 months and older with a diagnosis of acute bronchitis/ bronchiolitis that did not result in an antibiotic during episode of care.

54.06% 61.25%

15. Hemoglobin A1c Control for Patients with Diabetes

Percentage of members 18–75 years of age with diabetes (types 1 and 2) whose hemoglobin A1c (HbA1c) is within control (<8%) 64.96% 67.88%

Percentage of members 18–75 years of age with diabetes (types 1 and 2) whose hemoglobin A1c (HbA1c) is within control (<9%) 24.81% 21.31%

ATAMMC PWS Exhibit Q Health Plan Employer Data and Information Set (HEDIS)