2021 HEDIS Measures

2022 HEDIS MeasuresPREVENTIVE SCREENING2022 MeasureQuality IndicatorChildhood Immunization Children who turn 2 duringthe measurement yearPercent of fully immunized 2-year-olds 4 DTaP 4 Pneumococcal conjugate 3 Hep B 3 HIB 3 IPV 2 or 3 Rotavirus 2 Influenza 1 Hep A 1 MMR 1 VZVAdolescent Immunization Adolescents who turn 13during the measurement yearPercent of fully immunized 13-year-olds 1 Meningococcal vaccine between 11 and 13 birthday 1 TD or Tdap on or between 10 and 13 birthday 2 or 3 doses of the HPV vaccine by their 13 birthday For 2 doses, must be administered at least 146 days apart.Lead Screening Children who turn 2 duringthe measurement yearPercent with at least one capillary or venous blood test for leadpoisoning.Breast Cancer Screening Women age 50-74Percent who have had a mammogram during the measurementyear or 15 months prior to the measurement year.Cervical Cancer Screening Women age 21-64Percent who have had one of the three screenings for cervicalcancer such as: Woman 21-64 who had a Pap during the measurementyear, or the two years prior to the measurement year Women 30-64 who had a Pap and HPV test with the sameservice dates during the measurement year or the fouryears prior to the measurement year. Woman 30-64 who had a high- risk HPV test during themeasurement year or the four years prior to themeasurement year.Percent who have had one of five screenings for colorectal cancersuch as: Fecal occult blood test in the measurement year FIT-DNA Test in the last three years Flexible sigmoidoscopy in the last five years CT colonography in the past five years Colonoscopy in the last 10 yearsColorectal Screening Adults age 50-75HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).G-3245 Beecher Road Flint, Michigan 48532tel 888-327-0671 fax 1/20221

2022 HEDIS MeasuresPREVENTIVE SCREENING, continued2022 MeasureQuality IndicatorWeight Assessment and Counseling forNutrition & Physical Activity forChildren/Adolescents Children and adolescentsage 3-17Percent who have had an outpatient visit with a PCP or OB-GYNduring the measurement year with evidence of: BMI percentile documentation Counseling for nutrition Counseling for physical activityChlamydia Screening Women age 16-24Percent of sexually active members who have had one testfor Chlamydia during the measurement year.OVERUSE AND APPROPRIATENESS2022 MeasureQuality IndicatorUse of Opioids at High Dosage Adults age 18 and olderThe rate per 1,000 receiving prescription opioids for 15 daysduring the measurement year at a high dosage (averagemorphine equivalent dose [MME] 90 mg.)Use of Opioids from Multiple Providers Adults age 18 and olderThe rate per 1,000 receiving prescription opioids for 15 daysduring the measurement year who received opioids frommultiple providers or pharmaciesRisk of Continued Opioid Use Adults Age 18 and olderThe percentage of members who have a new episode ofopioid use that puts them at risk for continued opioid use.Two rates are reported: At least 15 days of prescription opioids in a 30-dayperiod At least 31 days of prescription opioids in a 62-dayperiodAdolescent females 16-20 years of age who were screenedunnecessarily for cervical cancer.Non-Recommended Cervical CancerScreening in Adolescent Females (NCS) Adolescent females 16-20 years ofageAppropriate Treatment for URIPercent of members with a diagnosis of URI who were NOT Members age 3 months and older dispensed an antibiotic.HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).G-3245 Beecher Road Flint, Michigan 48532tel 888-327-0671 fax 1/20222

2022 HEDIS MeasuresOVERUSE AND APPROPRIATENESS,2022 MeasureCONTINUEDQuality IndicatorUse of Imaging Studies for Low BackPain Adults age 18-75Percent of members with a primary diagnosis of low back pain,who have had NO imaging in the 28 days following the initialdiagnosis.Percent of members with a diagnosis of acute bronchitis who wereAvoidance of Antibiotic TreatmentNOT dispensed an antibiotic.for Acute Bronchitis/Bronchiolitis Members age 3 months and olderUTILIZATION2022 MeasureQuality IndicatorWell-Child Visits First 30 months of lifeChild and Adolescent Well-Care Visits Patients age 3-21The percentage of members who had the following number ofwell-child visits with a PCP during the last 15 months. Thefollowing rates are reported: Children who turned 15 months old during themeasurement year: Six or more well-child visits Children who turned 15-30 months old duringthe measurement year: Two or more well-childvisitsPercent of members who have had at least one comprehensive wellvisit with a PCP or OB-GYN practitioner during the measurementyear.HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).G-3245 Beecher Road Flint, Michigan 48532tel 888-327-0671 fax 1/20223

2022 HEDIS MeasuresBEHAVIORAL HEALTH2022 MeasureQuality IndicatorAntidepressant MedicationManagement Adults age 18 and olderFollow-up Care for Children PrescribedADHD Medication Members age 6-12Follow-up After Hospitalization forMental Illness Members 6 and olderPercent of members who were treated with antidepressantmedication, had a diagnosis of major depression and whoremained on an antidepressant medication treatment. Two ratesare reported: Acute Phase: members who remained on anantidepressant for at least 84 days Continuation Phase: The percentage of memberswho remained on an antidepressant medicationfor at least 180 daysPercent of children newly prescribed ADHD medication who hadfollow up visits within a 10-month period. Two rates are reported: Initiation Phase: One follow up visit within 30 days of thestart of the medication Continuation and Maintenance Phase: Two additionalfollow up visits in addition to the initiation visit within31300 days after the start of a medicationPercent of discharges for members who were hospitalized fortreatment of selected mental health disorders that within 7 daysof discharge, and within 30 days of discharge, had one of thefollowing with a mental health provider: An outpatient visit An intensive outpatient encounter, or A partial hospitalization A community mental health center visit Electroconvulsive therapy A telehealth visit An observation visit Transitional care management servicesHEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).G-3245 Beecher Road Flint, Michigan 48532tel 888-327-0671 fax 1/20224

2022 HEDIS MeasuresBEHAVIORAL HEALTH, continued2022 MeasureQuality IndicatorDiabetes Monitoring for People withDiabetes and Schizophrenia Adults age 18-64Percent of members with schizophrenia and diabetes whohad both LDL-C and HbA1c test during the measurementyear.Cardiovascular Monitoring for People withCardiovascular Disease and Schizophrenia Adults age 18-64Percent of members with schizophrenia and cardiovasculardisease, who had an LDL-C testing during the measurementyear.Follow up After High Intensity Care forSubstance Use Disorder Members age 13 and olderPercent of members who had an inpatient, residentialtreatment or detoxification visit for a diagnosis of substanceuse disorder who had a follow up visit for substance usedisorder: Follow up visit within 7 days after discharge or visit Follow up visit within 30 days after discharge or visitAdherence to Antipsychotic Medicationsfor Individuals with Schizophrenia Adults 18 and olderPercent of members diagnosed with schizophrenia whowere dispensed and remained on an antipsychoticmedication for at least 80% of the treatment period.Pharmacotherapy for Opioid UseDisorder Members age 16 and olderPercent of new opioid use disorder pharmacotherapyevents for 180 or more days for members with adiagnosis of OUD. No gaps in treatment of 8 or more consecutivecalendar daysPercent of children and adolescents who had two ormore antipsychotic prescriptions and had metabolictesting. Three rates are reported: Received blood glucose testing Received cholesterol testing Received blood glucose and cholesterol testingMetabolic Monitoring for Children andAdolescents on Antipsychotics Members age 1-17HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).G-3245 Beecher Road Flint, Michigan 48532tel 888-327-0671 fax 1/20225

2022 HEDIS MeasuresBEHAVIORAL HEALTH, continued2022 MeasureFollow-up After EmergencyDepartment Visit for Mental Illness Members 6 and olderQuality IndicatorPercent of members with emergency department visits with aprincipal diagnosis of mental illness or intentional self-harm whohad a follow up visit formental illness: Follow up visit within 7 days of ED visit Follow up visit within 30 days of ED visitFollow-up After EmergencyDepartment Visit for SubstanceUse Members 13 and olderPercent of members with emergency department visits with aprincipal diagnosis of substance use disorder (SUD), or anydiagnosis of drug overdose who had a follow up visit: Follow up visit within 7 days of ED visit Follow up visit within 30 days of ED visitDiabetes Screening for People withSchizophrenia or Bipolar DisorderWho are Using Antipsychotics Adults age 18-64Percent of members with schizophrenia or bipolar disorder whowere dispensed an antipsychotic medication and had a diabetesscreening test (glucose or HbA1c) during the measurement year.HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).G-3245 Beecher Road Flint, Michigan 48532tel 888-327-0671 fax 1/20226

2022 HEDIS MeasuresRESPIRATORY CONDITIONS2022 MeasureQuality IndicatorAppropriate Testing for Pharyngitis Members age 3 and olderPercent of members with a diagnosis of pharyngitis who weredispensed an antibiotic and received a strep test for theepisode of care.Use of Spirometry Testing in theAssessment and Diagnosis of COPD Members age 40 and olderPercent of members with a new diagnosis of COPD whoreceived a spirometry to confirm diagnosis.Pharmacotherapy Management of COPDExacerbation Members age 40 and olderThe percent of COPD exacerbations for members who had anacute inpatient discharge or ED visit on or between Jan. 1Nov. 30 of the measurement year, who were dispensedappropriate medications. Two rates are reported: Dispensed a systemic corticosteroid (or evidence ofanactive prescription) within 14 days of the event Dispensed a bronchodilator (or there was evidence of anactive prescription) within 30 days of the eventPercent of members who were identified as having persistentasthma and had a ratio of controller medications to totalasthma medications of 0.50 or greater during themeasurement year.Asthma Medication Ratio Age 5-64HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).G-3245 Beecher Road Flint, Michigan 48532tel 888-327-0671 fax 1/20227