What Is The NCQA : Healthcare Effectiveness Data And Information Set?

Healthcare is in a constant state of change with movements that impact rates, access and quality of care. Hospitals have become more competitive due to the rising cost of care delivery and the reduction in reimbursement from payers. This causes difficulty in delivering quality care to all patients, which is being measured by mandated patient perception surveys, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores are part of value

In recent years, the number of cases diagnosed with ADHD skyrocketed from 4 million per year to 10.4 million in children (King, 2013).

What is HEDIS? This abbreviation stands for the Healthcare Effectiveness Data and Information Set. This information set has morphed in its usefulness since 1991, where it was first termed the “HMO Employer Data and Information Set” (AHRQ, 2010). Since its inception, this information has been used by a majority of the country’s health care plans to evaluate performance. Today, the data sets allow for evaluation and more fluid comparison of certain areas of care and service. Furthermore, HEDIS comprises eighty-one measures that spans over five domains of care. Due to this amount of information gathered, stakeholders are given the opportunity to compare different plans in similar terms. In addition, the healthcare plans have the availability to view their own rankings to make necessary adjustments. The data sets are also examined to assess which plan is best for employers and employees based on specific needs. This data is also utilized when seeking accreditation and is now a powerful reimbursement tool. The HEDIS results are accessible for stakeholders via Quality Compass, which is a web-based tool that allows one to view and compare benchmark information (HEDIS, 2015).

The trend of over medicating children with ADHD is labeled well with the phrase anesthetization of our youth. “Anesthetize- deprive if feeling or awareness.” (Oxford Dictionary, 2014) Many children often express to their parents that they feel as if they are a walking zombie. A child may find that they are having memory issues, are not quite themselves, and feel overly drowsy. “ADHD medications often change a child’s personality creating what many kids with ADHD (and their parents) refer to as a zombie state or making them more aggressive.” (Barnett H., P. 1, 2013) Children with ADHD have other options for treatment but unfortunately medications are pushed on them at an alarming rate. The government paved the road for the pharmaceutical industry for ADHD medications in the 1990’s.

The increase of ADHD diagnosis has raised many concerns among doctors in the United States. In 2013, the Centers for Disease Control and Prevention reported new data that showed the number of children diagnosed with ADHD grew by 22 percent in a four-year period Brown University, (2013). The information from the Center for Disease Control & Prevention (CDC) raised questions and concerns about the growth of ADHD diagnosis. The Centers for Disease Control and Prevention (CDC) also stated that the percentage of children with a diagnosis of ADHD continue to increase in the United States. This information was provided by the Centers for Disease Control & Prevention (CDC) to inform the public and raise awareness for ADHD. Researching the growth of

Over the past couple of decades there has been a huge increase in the diagnosis and prescriptions given out for Attention Deficit Hyperactivity Disorder. According to a news report done by USA Today over the past five years use of ADHD medications have risen 40% totaling 39.5 million individual prescriptions ("New findings," 2009). When statistics like this are seen it is only normal for someone to ask questions. People are becoming curious about the legitimacy of the disorder, and whether or not the treatments being given to individuals are appropriate. The argument seems to be strong on both sides of the fence, but the extensive research done on ADHD leaves it hard for one to believe that it is a made up disorder.

In 2004, the Healthcare Effectiveness Data and Information Set (HEDIS) stated that “Kaiser Permanente Southern California (KPSC) region, where approximately 6,000 physicians in the Southern California Permanente Medical Group, and where approximately of 3.5 million adults and pediatric are treated, there performance was below the national 50th percentile”. (Kanter et al., 2013) Since the performance was below what they aspired to achieve, in 2005 KPSC recognized the potential to improve quality of care through providing complete care for patients who have chronic illness.

1). The IHI initiated this new framework of care because chronic health issues have become a global dilemma that has placed larger demands on healthcare systems, along with the aging population and longevity (IHI, 2016a). Other countries health systems outperform the United States in quality and cost in providing services for their citizens (IHI, 2016a). In order to meet the growing need for healthcare systems performance and to accommodate more enrollees through the ACA, healthcare providers and organizations must change their approach in providing healthcare for the public.

The number of children who received Medicaid in 2011 between the ages of 2-5 years was 106,468 and 11,895 children aged 2-3 years, they were enrolled in 34 Medicaid programs that provided clinical care for ADHD. The percentage rates have increased from 1.34% to 1.50% from 2008 to 2011 where children received clinical care, approximately 79% of those children whose age ranged from 2-5 years also received a prescription medication to help treat the disorder, while children receiving psychological services was approximately 53%, and children who received only medication with no other services provided for treatment was approximately 40%. During the study of Medicaid coverage compared to Employer Sponsored Insurance (ESI), 2.9% of children receiving clinical care covered by Medicaid was higher than those who were covered by ESI, there was no real difference in insurance coverage between Medicaid and ESI of children who claimed they were taking medication to treat ADHD. Out of the 150,000 insured children in 2011, over two-thirds received Medicaid benefits, with a positive diagnosis of ADHD. Consequently, if a child is diagnosed with ADHD they could be eligible for state disability benefits. Therefore, medication may be the only treatment for a child diagnosed with ADHD (Visser, et al…, 2016). With the costly expense of providing behavior therapy, most states do not offer clinical care services. According to The Policy Surveillance Program, A LawAtlas Project and

As a way to analyze and measure the progress of those six aims, the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, was established to “compare ‘apples to apples’… and to support consumer choice” as well as a means to evaluate a multitude of hospitals on a common ground (HCAHPS Hospital Survey). HCAHPS surveys are provided to patients after their patient-care experience. The full print survey can be

Imagine if your child’s check up with the doctor resulted in your child being diagnosed with ADHD. You begin to ask yourself questions. Why? Did I ever notice it before? Could the doctor be wrong? Is it something I could have prevented? Will my child live a normal life? Now imagine over 5 million parents sitting in their child’s doctor’s office asking these same questions. Children across America continue to be over diagnosed with Attention Deficit Hyperactivity Disorder also known as ADHD and rates continued to rise within the ongoing years.

The Healthcare Effectiveness Data and Information Set, HEDIS, is used by more than 90% of health insurance plans to evaluate the performance on the basis of care and service. HEDIS makes it easy for customers to compare different health plans on similar basis as it has specifically defined measures. Health plans use HEDIS results to measure their progression and determine what exactly they need to focus on to make a development. HEDIS is a trade mark owned by NCQA. Cigna PPO uses HEDIS data to compare themselves with other insurers. (NCQA.org, 2015)

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey is a tool used to collect standardized information that analyzes the experience of enrollees' through health plans and their services. The intent is to design a support system that assesses consumer’s performance with the health plans and it allows them to choose the plan that best suits their needs. It was first launched in 1997 and has now become the national standard when it comes to both determining and reporting the experiences of consumers through their health plan. Almost every state conducts this form of standardization and sponsors within the U.S. include health plans, state agencies who regulate health care, as well as federal agencies, such as the Department of Defense and Centers for Medicare & Medicaid Services.

From the very beginning of the research, the authors were very detailed with background information about the ADHD prescription phenomenon reporting that the rise in the number of

Were considered to be prevalent users. The theoretical duration of use of each prescription was calculated using information about the dispensing date, the number of units dispensed and the prescribed dosage regimen. Discontinuation of ADHD treatment was defined as not having