Last update: October 16, 2020
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.
At least one comprehensive well-care visit with a primary care provider (PCP) or an OB-GYN each year (ages 12-21)
Visits to include health history, physical exam, physical developmental history, mental developmental history and anticipatory guidance
An annual outpatient visit for members, ages 3-17, with a PCP or OB-GYN, including:
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
Upper respiratory infection (URI) diagnosis with no antibiotic prescription for members ages 3 months and older
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
Options for screening women for cervical cancer: cytology and high-risk human papillomavirus (hrHPV)
Adequately controlled blood pressure within the past year for members with a hypertension (HTN) diagnosis (ages 18-85)
Members, ages 18-75, with a diagnosis of diabetes who require the following:
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).
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.
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 Link button in the top right corner. Then go to Document Vault > External Documents > 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