Performance Summary Against Maryland and National Benchmarks
Report Year
Report Year 2017
The information provides a summary of clinical performance measures and indicators, as well as an account of how many of the Maryland health benefit plans had quality and performance scores equivalent to or better than the Maryland average, performance scores at or better than the National average, and performance scores at or better than the top ten percent nationally. Notes specific to each measure, where appropriate, are provided.
The information provides a summary of clinical performance measures and indicators, as well as an account of how many of the Maryland health benefit plans had quality and performance scores equivalent to or better than the Maryland average, performance scores at or better than the National average, and performance scores at or better than the top ten percent nationally. Notes specific to each measure, where appropriate, are provided.
Excellent Performance Areas
Maryland’s health benefit plans are maintaining a track record of good performance across many of the measures and indicators being evaluated. When considering all measures, several stand out for high performance and corresponding star assignment.
1. In the category Primary Care and Wellness for Children and Adolescents, the results show that adolescents and young adults 12 to 21 years of age receive at least one well-child visit each year, and the majority of plans ensure adolescents receive the required immunizations by their 13th birthday.
Adolescent Well-Care Visits
Adolescent Required Immunizations by 13th Birthday
2. In the category Respiratory Conditions – Adult and Child, the results show that health benefit plans are maintaining appropriate testing for children with pharyngitis and appropriate treatment for children with an upper respiratory infection. Additionally, recommended long term medication for asthma showed a 75% treatment compliance for members aged 5 to 85 years of age.
Appropriate Testing for Children with Pharyngitis
Appropriate Treatment for Children with Upper Respiratory Infection
Asthma Controller Medication Ratios >= 75% (5 to 85 years of age)
3. In the category Primary Care for Adults – Cardiovascular Conditions and Diabetes, the results show that adults 50 to 75 years of age are receiving appropriate colorectal cancer screening.
Statin Therapy for Patients with Diabetes (80% adherence)
Appropriate Colorectal Cancer Screening (50 to 75 years of age)
4. In the category of Behavioral Health, the results indicate that anyone admitted for depression is provided the appropriate medication coverage and that children on antipsychotics receive metabolic testing for blood glucose and cholesterol.
Antidepressant Medication Management (Acute Phase Treatment of 84 days)
Metabolic Monitoring for Children and Adolescents on Antipsychotics
Areas That Need Improvement
Overall, the health benefit plans continue to perform well when compared to the national average. In fact, rates were up in all areas in comparison to prior years of reporting and areas needing improvement decreased. However, there are several areas where overall performance is less than desired and the corresponding star assignment is low.
1. In the category Primary Care and Wellness for Children and Adolescents, the results show that health benefit plans are providing the required HPV antigen as a means of preventing cervical cancer to a small percentage of adolescents. In 2017, this requirement was extended to male adolescents and the measure is reported as Combo 2 of the Immunization for Adolescents measure.
Immunizations for Adolescents (Combo 2)
2. In the category Primary Care for Adults – General Health, the results show that HMO plans are providing body mass index screening to adults age 18-74 years old at lower rates than the national average.
Adult Body Mass Index Assessment
3. In the category Respiratory Conditions – Adult and Child, the results show that adults enrolled in a PPO plan are not appropriately treated with antibiotics for bronchitis.
Appropriately Not Given Antibiotics- 18 To 64 Years of Age.
Maryland Average Benchmark (MAB)
Maryland Average Benchmark (MAB): The Maryland Average Benchmark is an average of the rates as reported to NCQA for the health benefit plans in this report. The average is calculated for eight HMOs and authorized HMO combinations such as HMO/POS plan combinations and seven PPOs and authorized PPO combinations such as PPO/EPO plan combinations. If a health benefit plan reported: NA, indicating Not Applicable due to an insufficient eligible population (e.g., <30 members, or <100 survey respondents) to calculate a rate; NB, indicating No Benefit offered by the health benefit plan; UN, measure was unaudited: BR, indicating the performance score was bias and not reported; then the NA, NB, BR, and UN performance results were not included in the calculation of the Maryland Average Benchmark.
National Average Benchmark (NAB)
National Average Benchmark (NAB): The National Average Benchmark is an average of the rates as reported to NCQA for all of the health benefit plans across the United States and its territories. A mean value of each reported rate is taken from NCQA’s HEDIS® Audit Means, Percentiles and Ratios – Commercial HMO/POS and Commercial PPO Plans, which is released to the public each year. The NCQA data set gives prior year rates for each measure displayed as the mean rate and the rate at the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. NCQA averages the rates of all organizations submitting HEDIS® performance results gathered through the administrative, supplemental or hybrid methods. Therefore, the method for calculating the NAB is the same as that used for calculating the MAB, but on a larger scale. The star assignment is based on plan performance in relationship to the percentiles. The percentiles used here are based on quality and performance reported in 2016.
National Top Performers (NTP) Benchmark
National Top Performers (NTP) Benchmark: The National Top Performers benchmark represents one of the highest performance levels that can be achieved by health benefit plans. When all of the performance scores reported to NCQA for a particular measure are compared, the NTP marks the bar where eighty-nine percent of the health benefit plans had a lower score and ten percent had a higher score. The NTP is different from the MAB and NAB, which are averages calculated from all reported performance scores. The NTP represents a specific placeholder of all scores reported when they are sorted from lower to higher performance score. It serves as a clear indication and comparison of the health benefit plan’s performance in comparison to peers reporting the same product without regard to size of health benefit plan or geographic service area. A health benefit plan is to be applauded if they meet or exceed the NTP benchmark.
Health Plans Achieving NTP Standards
Please Select A Health Plan Below to see which measures met the NTP Standard.
Aetna HMO
Number of measures achieving National Top Performance levels: 2
Medication Management for People with Asthma (75%)
• 19-50 years of age
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
CareFirst BlueChoice HMO
Number of measures achieving National Top Performance levels: 5
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
• Initiation 13-17 years
• Engagement 13-17 years
Antidepressant Medication Management
• Effective Continuation Phase
Medication Management for People with Asthma (75%)
• 19-50 years of age
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
CareFirst Maryland HMO
Number of measures achieving National Top Performance levels: 19
Adults’ Access to Preventive/Ambulatory Health Services
• 20-44 years
• 45 - 64 years
Antidepressant Medication Management
• Effective Acute and Continuation Phases
Metabolic Monitoring for Children and Adolescents on Antipsychotics
• 1-17 years of age
Persistence of Beta-Blocker Treatment After a Heart Attack
Childhood Immunization Status
• Combo 10
Immunization for Adolescents
• Combo 1
Appropriate Testing for Children with Pharyngitis
Pharmacotherapy Management of COPD Exacerbation
• Systemic Corticosteroid
• Bronchodilator
Medication Management for People with Asthma (all 10 indicators)
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
CareFirst GHMSI HMO
Number of measures achieving National Top Performance levels: 5
Adults’ Access to Preventive/Ambulatory Health Services
• 45-64 years of age
Children and Adolescents' Access to Primary Care Practitioners
• 12-24 months of age
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
• Engagement 13-17 years
Appropriate Testing for Children with Pharyngitis
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
KaiserPermanente HMO
Number of measures achieving National Top Performance levels: 42
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
• Engagement 18+ years of age
• Total 18+ years of age
Prenatal and Postpartum Care
• Timeliness of Prenatal Care
• Postpartum Care
Follow-Up Care for Children Prescribed ADHD Medication
• Initiation
• Continuation
Metabolic Monitoring for Children and Adolescents on Antipsychotics
• 12-17 years of age
• 1-17 years of age
Controlling High Blood Pressure
Persistence of Beta-Blocker Treatment After a Heart Attack
Statin Therapy for Patients with Cardiovascular Disease
• Received Statin Therapy: All age groups and Total
Comprehensive Diabetes Care
• HbA1c testing and levels
• Medical attention for nephropathy
• Eye Exam
• BP Control (<140/90)
Statin Therapy for Patients with Diabetes
• Received Statin Therapy
Annual Monitoring for Patients on Persistent Medications
• ACE inhibitors or ARBs
• Digoxin
• Diuretics
Appropriate Treatment for Children with Upper Respiratory Infection
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
Adult BMI Assessment
Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents
• BMI Percentile 3-17 years if age
• Counseling for Nutrition 3-17 years if age
• Counseling for Physical Activity 3-17 years if age
Immunizations for Adolescents
• Combo 1
Human Papillomavirus Vaccine for Female Adolescents
Breast Cancer Screening
Cervical Cancer Screening
Colorectal Cancer Screening
Chlamydia Screening in Women
• 16-24 years of age
Appropriate Testing for Children with Pharyngitis
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
MD IPA HMO
Number of measures achieving National Top Performance levels: 5
Immunizations for Adolescents
• Combo 1
Asthma Medication Ratio
• Ages 5-11
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
• 1 visit
• 3 visits
OptimumChoice HMO
Number of measures achieving National Top Performance levels: 4
Immunizations for Adolescents
• Combo 1
Medication Management for People with Asthma 51-64 years of age
• 50%
• 75%
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
UnitedHealthcare HMO
Number of measures achieving National Top Performance levels: 3
Children and Adolescents’ Access to Primary Care Practitioners
• 12 - 24 Months
Immunizations for Adolescents
• Combo 1
Childhood Immunization Status
• Combo 10
Aetna PPO
Number of measures achieving National Top Performance levels: 9
Antidepressant Medication Management
• Effective Acute and Continuation Phases
Metabolic Monitoring for Children and Adolescents on Antipsychotics
• 12-17 years of age
• 1-17 years of age
Persistence of Beta-Blocker Treatment After a Heart Attack
Non-Recommended Cervical Cancer Screening in Adolescent Females
Appropriate Testing for Children with Pharyngitis
Asthma Medication Ratio
• 51-64 years of age
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
CareFirst Maryland PPO
Number of measures achieving National Top Performance levels: 16
Adults’ Access to Preventive/Ambulatory Health Services
• 45 - 64 years of age
Antidepressant Medication Management
• Effective Acute Phase Treatment
• Effective Continuation Phase Treatment
Follow-Up Care for Children Prescribed ADHD Medication
• Initiation
• Continuation
Metabolic Monitoring for Children and Adolescents on Antipsychotics
• 12-17 years of age
• 1-17 years of age
Persistence of Beta-Blocker Treatment After a Heart Attack
Annual Monitoring for Patients on Persistent Medications
• Digoxin
Immunizations for Adolescents
• Combo 1
Pharmacotherapy Management of COPD Exacerbation
• Bronchodilator
Medication Management for People with Asthma
• 5-11 years of age: 75%
• 51-64 years of age: 50%
• 51-64 years of age: 75%
Asthma Medication Ratio
• 19-50 years of age
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
CareFirst GHMSI PPO
Number of measures achieving National Top Performance levels: 15
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
• Initiation 18+ years of age
• Initiation 13+ years of age
Antidepressant Medication Management
• Effective Acute Phase Treatment
• Effective Continuation Phase Treatment
Follow-Up Care for Children Prescribed ADHD Medication
• Initiation
• Continuation
Metabolic Monitoring for Children and Adolescents on Antipsychotics
• 12-17 years of age
• Total 1-17 years of age
Comprehensive Diabetes Care
• Medical attention for nephropathy
Statin Therapy for Patients with Diabetes
• 80% adherence
Metabolic Monitoring for Patients on Persistent Medications
• 12 – 17 years of age
• Total
Statin Therapy for Patients with Cardiovascular Disease
• Received Statin Therapy – Total
Statin Therapy for Patients with Diabetes
• Received Statin Therapy
Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents
• Counseling for Nutrition - Total
Appropriate Testing for Children with Pharyngitis
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
Cigna PPO
Number of measures achieving National Top Performance levels: 12
Children and Adolescents’ Access to Primary Care Practitioners
• 12 - 24 Months
Prenatal and Postpartum Care
• Timeliness of Prenatal Care
Metabolic Monitoring for Children and Adolescents on Antipsychotics
• 6-11 years of age
• 12-17 years of age
• Total 1-17 years of age
Comprehensive Diabetes Care
• HbA1c < 7
Use of Multiple Concurrent Antipsychotics in Children and Adolescents
• 6-11 years of age
Immunizations for Adolescents
• Combo 1
Appropriate Testing for Children with Pharyngitis
Asthma Medication Ratio
• 19-50 years of age
• 51-64 years of age
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
Kaiser Permanente PPO
Number of measures achieving National Top Performance levels: 17
Controlling High Blood Pressure
Comprehensive Diabetes Care
• HbA1c testing and levels
• Medical attention for nephropathy
• Eye Exam
• BP Control (<140/90)
Statin Therapy for Patients with Diabetes
• Received Statin Therapy
Annual Monitoring for Patients on Persistent Medications
• ACE inhibitors or ARBs
• Diuretics
Non-Recommended Cervical Cancer Screening in Adolescent Females
Use of Imaging Studies for Low Back Pain
Adult BMI Assessment
Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents
• BMI Percentile - Total
• Counseling for Nutrition - Total
• Counseling for Physical Activity - Total
Breast Cancer Screening
Cervical Cancer Screening
Colorectal Cancer Screening
MAMSI PPO
Number of measures achieving National Top Performance levels: 12
Adults’ Access to Preventive/Ambulatory Health Services
• 20-44 years of age
Children and Adolescents’ Access to Primary Care Practitioners
• 12-24 months of age
• 25 months – 6 years of age
• 7-11 years of age
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
• Engagement 18+ years of age
• Total 18+ years of age
Statin Therapy for Patients with Diabetes
• Received Statin Therapy
Childhood Immunization Status – Combo 10
Appropriate Testing for Children with Pharyngitis
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
UnitedHealthcare PPO
Number of measures achieving National Top Performance levels: 6
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
• Engagement 13-17 years of age
Use of Multiple Concurrent Antipsychotics in Children and Adolescents
• 12-17 years of age
Comprehensive Diabetes Care
• HbA1c < 8
Immunizations for Adolescents
• Combo 1
Appropriate Testing for Children with Pharyngitis
Well-Child Visits in the First 15 Months of Life
• 0 visits (reverse scoring)
