HEDIS and Quality Initiatives

NEW: HEDIS Poster

2017 Performance Poster that provides tips for MDwise providers on important preventive and clinical measures.


2017 Pay For Outcomes Program For Providers of OB Services

The State of Indiana, through the Family and Social Services Administration(FSSA), contracts with health plans to provide health care services to Hoosier Healthwise and Healthy Indiana Plan(HIP) enrollees in Indiana. As a reward for providing care that meets the standards of high quality pregnancy care, FSSA offers Pay For Outcomes(P4O) for the Health Plans. On an annual basis, FSSA establishes benchmarks for a set of quality measures defined in the health plan contract and offers additional payment when the health plans meet established goals.


2017 Pay For Outcomes Program

The State of Indiana, through the Family and Social Services Administration(FSSA), contracts with health plans to provide health care services to Hoosier Healthwise and Healthy Indiana Plan(HIP) enrollees in Indiana. As a reward for providing care that meets the standards of high quality preventative care FSSA offers Pay For Outcomes(P4O) for the Health Plans. On an annual basis, FSSA establishes benchmarks for a set of quality measures defined in the health plan contract and offers additional payment when the health plans meet established goals.


Vaccine Schedule

Vaccine schedule for all children from birth to 16 years of age provided by Indiana Immunization Coalition. The provided vaccination schedules are compatible with recommendations of the Advisory Committee on Immunization Practices (ACIP), the US Center For Disease Control (CDC), The American Academy of Pediatrics (AAP) and The American Academy of Family Physicians (AAFP) and endorsed by the Indiana State Department of Health.


Access to Care Guidelines

An integral part of patient care is making sure patients have access to needed medical care. In accordance with the OMPP policy and NCQA standards, MDwise establishes standards and performance monitors to help in ensuring that MDwise members receive timely and clinically appropriate access to providers and covered services.
 

Indiana Health Coverage Programs (IHCP) Relationship Chart

 

Fax Back Program

The HEDIS fax back program allows providers to submit evidence of one or more of the following services, where a claim cannot be submitted, which include:  
This information is used in calculating HEDIS-based performance rates for participating MDwise providers.
                 
Tip Sheet | All Inclusive Form


40 Weeks of Pregnancy Provider Toolkit

Learn more about the new state-wide quality initiative to address elective inductions and cesarean sections that are not medically necessary. The toolkit contains important information on recent research studies as well as provider tools and patient education.

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

CAHPS is an important member satisfaction survey conducted by health plans annually, in the spring of each year. The survey asks consumers and patients to report on and evaluate their experiences with their health care.  
 

SMOKE-free Resources for Providers

The MDwise medical benefit covers smoking cessation services for HIP and Hoosier Healthwise members in the form of tobacco cessation counseling services.  
 

Presumptive Eligibility (PE) and Notification of Pregnancy Programs


Well-Child Care/EPSDT

 

Best Practices for Well-Child 0–15 Months

Actively pursue missed appointments with letters and reminder calls. Reminder calls made later in the day or early evening may result in more contacts being made to the members.
 

AAP Periodicity and Screening Schedule ­

Recommendations for preventive pediatric health care from Bright Futures/American Academy of Pediatrics.
 

Indiana Medicaid EPSDT

HealthWatch/EPSDT provider manual
 

Lead Poisoning is Preventable Poster

This poster explains the importance of performing lead screenings on all children.