Health plans and physicians must ensure they are meeting standards set by the accreditation agencies, such as NCQA. As a physician practice manager for Dr. Jones, you have just conducted a mock survey of the patient chart data. The data shows that your physician practice is not meeting standards for two HEDIS measures.
• Choose two HEDIS measures from the list below that must be implemented in a physician practice to improve patient outcomes.
o NCQA HEDIS Measures
Breast Cancer Screening:
Women aged 50 to 74 years who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy.
Medical Assistance with Smoking and Tobacco Use Cessation:
Assesses current smokers seen by a physician during the year who were advised to quit, and cessation medications were recommended and discussed. Different cessation methods were discussed.
• You must describe the sources of data needed to conduct the two measures. What source would you use to obtain the data? For example, if we were to look at patients receiving a beta blocker after discharge from the hospital, we would obtain data from pharmacy claims.
• Using one of the quality improvement models (i.e., Lean, PDSA, or Six Sigma), explain how you would use the model to implement one of the chosen HEDIS measures.
• Include information on how the quality initiatives chosen are linked to the rising costs of health care. Consider government mandates that have improved quality initiatives related to implementing the HEDIS measures or added to the burden of increased costs.