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August 01, 2022

Texas Medicaid: Measures that make a difference in patient care

Providing useful resources is one way we try to make it easier for you to care for your patients. We’ve summarized some of the 2022 state and federal key quality performance measures for health care consumers. The chart can serve as a useful tool for you to share with your team as you look for opportunities to improve patient care at your practice.

Summary of state and federal key quality measures
Appropriate Treatment for Upper Respiratory Infection (URI)
Patients ages 3 months and older with a diagnosis of URI do not receive an antibiotic prescription
Cervical Cancer Screening (CCS)

Women patients in the age groups listed below to receive the following cervical cancer screenings:

  • Ages 21–64 years: Cervical cytology in the measurement year or 2 years prior
  • Ages 30–64 years: Cervical cytology and high-risk human papillomavirus (hrHPV) co-testing in the measurement year or 4 years prior
  • Ages 30–64 years: Cervical high-risk human papillomavirus (hrHPV) testing in the measurement year or 4 years prior
Child and Adolescent Well-Care Visits (WCV)
Patients ages 3–12 years to receive at least 1 comprehensive WCV with a primary care provider (PCP) or obstetrician-gynecologist (OB-GYN) every year
Childhood Immunization Status (CIS)

Patients to receive the following vaccines by their second birthday:

  • Four diphtheria, tetanus and acellular pertussis (DTaP)
  • Three polio (IPV); 1 measles, mumps and rubella (MMR)
  • Three haemophilus influenza type B (HiB)
  • Three hepatitis B (HepB)
  • One chicken pox (VZV)
  • Four pneumococcal conjugate (PCV); 1 hepatitis A (HepA)
  • Two or 3 rotavirus (RV)
  • Two influenza (flu)
Controlling High Blood Pressure (CBP)
Patients ages 18–85 years with a hypertension (HTN) diagnosis to have adequately controlled blood pressure (<140/90 mm Hg) within the past year
Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
Patients ages 18–64 years who are diagnosed with having schizophrenia, schizoaffective or bipolar disorder and were dispensed an antipsychotic medication to receive a diabetes screening test
Follow-Up After Hospitalization for Mental Illness (FUH)
A mental health practitioner to perform a follow-up visit within 7 days after discharge for patients ages 6 years and older who were hospitalized for treatment of select mental illness or intentional self-harm diagnoses
Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication – Initiation Phase Attention Deficit Disorder (ADD)
Practitioners with prescribing authority to conduct 1 follow-up visit during the 30-day initiation phase for patients ages 6–12 years who have an ambulatory prescription for ADHD medication 
Hemoglobin A1C Control for Patients with Diabetes (HBD)
Patients ages 18–75 years with a diagnosis of type 1 or type 2 diabetes to maintain a hemoglobin A1C (HbA1c) level of < 8.0%
Immunizations for Adolescents (IMA)
Adolescents to receive 1 dose of meningococcal vaccine, 1 tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and complete the human papillomavirus (HPV) vaccine series on or before their 13th birthday
Prenatal and Postpartum Care (PPC)
  • Prenatal care: Patients to receive a prenatal care visit in the first trimester on or before the enrollment start date or within 42 days of enrollment in a UnitedHealthcare plan
  • Postpartum care: Patients to receive a postpartum visit on or between 7 and 84 days after delivery
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)

A PCP or OB-GYN to conduct an annual outpatient visit for patients ages 3–17 years, which will include:

  • Calculating body mass index percentile
  • Counseling for nutrition
  • Counseling for physical activity
Well-Child Visits in the First 30 Months of Life (W30)
  • Patients ages 0–15 months to receive 6 or more WCVs, which include health history, physical exam, physical and mental developmental history, and anticipatory guidance
  • Patients ages 15–30 months to receive 2 or more WCVs, which include health history, physical exam, physical and mental developmental history, and anticipatory guidance

Online resources 
The following online resources will provide you with a better understanding of care opportunities: 

  • PATH is our quality care program that provides specifications for many of the quality measures and tools used to address care opportunities, as well as how to report data, and what billing codes to use. Learn more about PATH, its features and additional tools at UHCprovider.com/path or contact your physician advocate. 
  • Patient Care Opportunity Report (PCOR) is a monthly report you can use to identify your patients’ adherence to preventive screenings, treatments and medications. Take the following steps to access your PCOR:
    • Go to UHCprovider.com and click the Sign In button in the top right corner 
    • Click Documents & Reporting > Physician Performance & Reporting > Open My Reports
  • Provider Express is our behavioral health site that connects health care professionals to clinical and administrative resources and educational information. Topics include clinical best practice documentation, recovery, well-being support and health management. To access these resources and more, go to providerexpress.com and login. You’ll need to create a profile if you’re a first-time user.

Questions?
For information about key quality measures or UnitedHealthcare online resources, reach out to your physician advocate at 888-887-9003. 

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