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MONITORING QUALITY


Gundersen Health Plan is dedicated to providing safe, effective, and efficient services. One way we monitor the quality of our health plan services is through voluntary participation in a program that collects and reports health plan performance data. This program is called HEDIS (Healthcare Effectiveness Data and Information Set). In the United States, more than 90 percent of health insurance plans participate in HEDIS data collection. 

HEDIS includes more than 70 standardized measures. These measures address many areas of care—from how many patients receive beta blocker medicines after a heart attack to how many have discussed physical activity with their healthcare provider.

Some consumers use HEDIS data to compare health plans and guide their annual coverage selection. We use the results to see where we can improve.

Gundersen Health Plan Commercial HMO 

Based on HEDIS 2014, Gundersen Health Plan’s Commercial HMO performs above the 90th percentile for many measures such as:

  • Controlling high blood pressure. The percentage of members 18 to 85 years of age who had a diagnosis of hypertension (high blood pressure) and whose blood pressure was controlled (less than 140/90). 
  • Childhood immunization status (Combination 2). The percentage of members who have received the following vaccines by their second birthday: at least four DTaP (diphtheria, tetanus and pertussis), at least three IPV (inactivated polio virus), at least one MMR (measles, mumps and rubella), at least three Hib (Haemophilus influenzae type b), and at least one VZV (varicella zoster virus, or chicken pox) vaccine. 

In addition, we are working to improve several measures, including: 

  • Antidepressant medication management. The percentage of members who are diagnosed with and prescribed a medication for depression who stay on the antidepressant medication for at least 12 weeks and at least 6 months.
  • Human papillomavirus (HPV) vaccine. The percentage of female adolescents who have three HPV vaccinations between ages 9 and 13.
  • Chlamydia screening in women ages 16 to 24.

    Gundersen Health Plan Senior Preferred (HMO) 

    Based on HEDIS 2014, Gundersen Health Plan’s Senior Preferred HMO performs above the 90th percentile for many measures, such as: 

    • Colorectal cancer screening—the percentage of members 50 to 75 years of age who had appropriate screening for colorectal cancer. 
    • Controlling high blood pressure—the percentage of members 18 to 85 years of age who had a diagnosis of high blood pressure and whose blood pressure was controlled (less than 140/90).

    In addition, we are working to improve measures, including: 

    • Antidepressant medication management—the percentage of members who are diagnosed with and prescribed a medication for depression who stay on the antidepressant medication for at least 12 weeks and at least 6 months. 

      For a more detailed overview of all quality measures or for a copy of our program evaluation or description, please contact Gundersen Health Plan Quality Management at (800) 897-1923. 

      The source for data contained in this article is Quality Compass. Quality Compass and HEDIS are registered trademarks of the National Committee for Quality Assurance.

       


       

      Gundersen Health Plan does not allow financial incentives to staff or healthcare practitioners/providers at any time. All Utilization Management decisions are based only on the appropriateness of care and services and the existence of coverage. Practitioners/providers, or other staff, are not specifically rewarded for issuing denials of coverage, service or care.