AlohaCare’s plan for QUEST members has been awarded Interim Health Plan Accreditation from the National Committee for Quality Assurance (NCQA). NCQA Health Plan Accreditation is a nationally recognized evaluation that purchasers, regulators and consumers can use to assess health plans. NCQA Health Plan Accreditation is a voluntary review process that evaluates the quality of health care that health plans provide to their members. It evaluates how well a health plan manages all parts of its delivery system -- physicians, hospitals, other providers and administrative services -- in order to continuously improve the quality of care and services provided to its members.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.
Clinical Practice Guidelines
AlohaCare uses evidence-based clinical practice guidelines developed by local and national associations. With the assistance of local physicians serving on our Medical and Behavioral Health Advisory Committees, the following guidelines have been adopted as minimum standards for AlohaCare providers.
- Adult Preventive Health (Updated 05/2012)
- Chronic Heart Failure (Updated 08/2013)
- Chlamydia (Updated 10/2013)
- Coronary Artery Disease (CAD) (Updated 08/2013)
- Adult Immunizations (Updated 08/2013)
- Child/Adolescent Immunizations (Updated 08/2013)
- Diabetes Mellitus (Updated 08//2013)
- Diagnosis and Treatment Management of Attention Deficit/Hyperactivity Disorder (ADHD) in School-Aged Children (Updated 10/2013)
- Management of Asthma (Updated 08/2013)
- Routine Prenatal and Postpartum Care (Updated 05/2012)
- Treatment for Patients with Major Depressive Disorder (Updated 10/2013)
“HEDIS” is an acronym for the Healthcare Effectiveness Data and Information Set, which is a set of standardized measures designed by the National Committee for Quality Assurance (NCQA) to evaluate the performance of health plans. It allows for the assessment of health plans on the basis of quality and performance. Since its introduction in 1993, HEDIS has evolved to become the “gold standard” in managed care performance measurement.
AlohaCare is required to report the results of several HEDIS indicators annually to our State regulators, the Hawaii Department of Human Services (DHS), and our Federal regulators, the Center for Medicaid and Medicare Services (CMS). By measuring HEDIS indicators annually, we are able to evaluate our performance achievements, monitor our quality improvement efforts, and identify further opportunities for improvement in our health care delivery efforts.
1. Introduction to HEDIS
2. HEDIS Provider FAQs