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TennCare Releases 2012 HEDIS/CAHPS Report

Thursday, January 03, 2013 | 08:48am

The state Medicaid program continues to see
improvements from Managed Care Organizations

NASHVILLE — The Bureau of TennCare today announced the results of the 2012 HEDIS/CAHPS Report: A Comparative Analysis of Audited Results from TennCare Managed Care Organizations (MCOs).  MCOs in Tennessee are required to report Healthcare Effectiveness Data and Information Set (HEDIS) data as part of the state’s accreditation mandate.  The information included in this report is for the previous calendar year.  

HEDIS is a set of standardized performance measures that makes it possible to track performance over time, compare MCO performance to national averages, and cross-reference performance between MCOs contracting with TennCare.  
In 2012 TennCare continues to exhibit strong performance in the area of child and adolescent health, including immunization rates, access to primary care practitioners and treatment of asthma.  Improvement was also noted in measures related to comprehensive diabetes care, treatment of chronic obstructive pulmonary disease (COPD), and follow-up care after hospitalization for mental illness.  
“I am pleased to see continued progress being made in relation to many of the measures reported by our MCOs,” said Health Care and Finance Administration Deputy Commissioner Darin Gordon.  “Our primary goal is to make high-quality, cost-effective care available to the Tennessee citizens who receive health insurance through the TennCare program.  We use the information contained in this annual report to track our progress toward that goal and to help us target areas where additional improvement is needed.” 
Areas of marked improvement from 2011 to 2012 include weight assessment and counseling for nutrition and physical activity for children and adolescents.  For members aged 3-17 years, the weighted state rate for counseling for nutrition was 56.30 percent – an increase of more than 33 percentage points from 2011 and 10.70 percentage points higher than the 2011 Medicaid national average.  Substantial improvement was also noted in adolescent immunization rates and well child visits in the first 15 months of life.  Other areas in which TennCare continues to perform above the national Medicaid average include lead screening in children, cholesterol screening in adults and treatment of alcohol and other drug dependence in adolescents.    
“The HEDIS report is a mechanism by which we measure and publicly report on the performance of TennCare health plans.  Since TennCare’s inception, the Bureau has implemented a number of different initiatives aimed at improving the access, affordability and quality of health care financed by the state of Tennessee and this report is just one such example,” said Gordon.      
In 2006 Tennessee became the first state in the country to require National Committee on Quality Assurance (NCQA) certification across its Medicaid managed care network.  NCQA is an independent, nonprofit organization that assesses and scores managed care organization performance in the areas of quality improvement, utilization management, provider credentialing and member rights and responsibilities. As part of the NCQA accreditation process, TennCare MCOs are also required to report a full Health Care Effectiveness Data and Information Set.  Included in HEDIS, is the Consumer Assessment of Health Care Providers and Systems (CAHPS), which is a set of standardized surveys used to measure members’ satisfaction with their care. It is a survey tool used widely for measuring consumer satisfaction with the quality of care and customer service provided by health plans.
To view the full report, visit

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