UnitedHealthcare Community Plan of Texas continually strives to make improvements that can make a difference in our members’ lives. One way we do this is by looking at the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures, which are gathered through a National Committee for Quality Assurance (NCQA) tool that can help find ways to enhance health care.
Adolescent Well-Care Visits (AWC)
At least one comprehensive well-care visit with a primary care provider (PCP) or an OB-GYN each year (ages 12-21)
Well-Child Visits in the First 15 Months of Life (W15)
Visits to include health history, physical exam, physical developmental history, mental developmental history and anticipatory guidance
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC)
An annual outpatient visit for members, ages 3-17, with a PCP or OB-GYN, including:
Body mass index (BMI) percentile
Counseling for nutrition
Counseling for physical activity
Immunizations for Adolescents (IMA)
Adolescents, who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and had completed the human papillomavirus (HPV) vaccine series on or before their 13th birthday
Appropriate Treatment for Upper Respiratory Infection (URI)
Upper respiratory infection (URI) diagnosis with no antibiotic prescription for members ages 3 months and older
Follow-Up After Hospitalization for Mental Illness (FUH)
Percentage of discharges for members, ages 6 and older, who were hospitalized for treatment of select mental illness or intentional self-harm diagnoses and had a follow-up visit with a mental health practitioner
Cervical Cancer Screening (CCS)
Options for screening women for cervical cancer: cytology and high-risk human papillomavirus (hrHPV)
Controlling High Blood Pressure (CBP)
Adequately controlled blood pressure within the past year for members with a hypertension (HTN) diagnosis (ages 18-85)
Comprehensive Diabetes Control (CDC)
Members, ages 18-75, with a diagnosis of diabetes who require the following:
Controlled hemoglobin A1C (HbA1c)
Eye exam (retinal)
Medical attention for nephropathy
Diabetes Screening for Members With Schizophrenia or Bipolar Disorder Who
Are Using Antipsychotics (SSD)
Diabetes screening test for members living with schizophrenia, schizoaffective or bipolar disorder who were dispensed an antipsychotic medication (ages 18-64)
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
We’re Here to Help With Online Tools
PATH is a UnitedHealthcare program that provides useful information about quality care standards related to HEDIS® and the Centers for Medicare & Medicaid Services (CMS) measures, new programs available and more. The follow are two of PATH’s helpful tools.
This web-based application allows the real-time tracking of members and their care opportunities. To gain access, contact your UnitedHealthcare Quality Representative.
Patient Care Opportunity Report (PCOR)
This tool monthly report provides clear and actionable information to identify patients’ adherence to preventive screenings, treatments and medications. To access your PCOR, go to UHCprovider.com and click the Sign In button in the top right corner. Then click Documents & Reporting from the menu > Physician Performance & Reporting > Open My Reports.
Visit UHCprovider.com/path or contact your Provider Advocate to learn more about the PATH program and its other features. Or call Member Services at 888-887-9003, Monday – Friday, 8 a.m. – 6 p.m. Central Time