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TennCare Releases 2013 HEDIS/CAHPS Report

Wednesday, October 09, 2013 | 10:12am
The state Medicaid program continues to see improvements from Managed Care Organizations
NASHVILLE — The Bureau of TennCare today announced the results of the 2013 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) information as part of the state’s accreditation mandate.  The information included in this report is for the previous 2012 calendar year. 

HEDIS is a set of standardized performance measures that allow for comparison not only to national Medicaid averages but also between the other state MCOs.  The HEDIS results also allow for measurements and tracking overtime allowing the state to assess health plan performance and reward initiatives that show improvement.      
In 2012 TennCare’s MCOs continued to exhibit improvements in effective care measures in the area of child and adolescent health, access to primary care practitioners and comprehensive diabetes care.  Improvements in areas such as breast cancer screening and cervical cancer screening were also noted.       
“The continued progress being made by our MCOs is a reflection of the high priority TennCare places on care quality,” Deputy Commissioner of Health Care Finance and Administration Darin Gordon said.  “Our primary goal is to make high-quality, cost-effective care available.  We rely on our health plans to make strategic investments in continuous quality improvement and the annual HEDIS report allows the state and the health plans to take an objective look at performance and track progress while also identifying areas where additional improvement is needed.” 
Specific examples of performance improvement include a marked increase from 2012 to 2013 in weight assessment and counseling for nutrition and physical activity for children and adolescents.  For members aged 12-17 years, the weighted state rate for counseling for physical activity was 48.02 percent – a 19 percent increase compared to the 2012 rate and 4.79 percentage points higher than the 2012 national Medicaid average.  Substantial improvement was also noted in follow-up care for children prescribed ADHD medication – performing above the 2012 weighted state rate as well as the national Medicaid rate.  TennCare continues to perform above the national Medicaid average in a variety of other areas including follow-up after hospitalization for mental illness and nearly all immunization rates for children and adolescents.  
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.  The recently released NCQA Health Insurance Plan Rankings show that out of 258 Medicaid health plans nationwide, 131 reported enough quality data to be officially assessed and ranked.  Of the managed care organizations in the Southeast region ranked by NCQA, seven of the top 20 health plans are TennCare plans.  As part of the NCQA accreditation process TennCare MCOs are 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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