HEDIS Prevention Performance Indicators, Prevention Quality Assessment and Healthy People 2010

Abstract

The purposes of the study were to contrast actual prevention services needs with quality assurance indicators from the Health Employer Data Information System (HEDIS-Medicaid 3.0) and the goals and objectives of Healthy People 2010, to calculate allowable Medicaid reimbursement for comprehensive prevention services, and to describe patient expectations for prevention counseling. We obtained a convenience sample of all ages (under 17 years = 514, 18 years or older = 473), both sexes (male = 393, female = 594), and three racial/ethnic groups: African American = 687, White =173, Hispanic = 88 in a clinic that predominantly served Medicaid-insured patients. Participants 18 years of age and older were interviewed about expectations for preventive counseling. According to procedures rated A or B by the second United States Preventive Services Task Force (USPSTF), these patients had 11,504 service needs. Performance indicators from HEDIS-Medicaid 3.0 would have covered 2,571 (22%) while the goals and objectives of Healthy People 2010 would have covered 11,437 (99%). Allowable Medicaid reimbursement estimates for 100% coverage averaged USD $206.13 per person. A majority of patients in all race-sex groups expected counseling at least once per year. The results show that a focus on HEDIS-Medicaid 3.0 quality indicators in these patients would have been inconsistent with the goals and objectives of Healthy People 2010, that it would have promoted patient mistrust by failing to meet patient expectations, and that payment for 100% coverage of A and B USPFTF recommended preventive services at Medicaid rates would have constituted a small fraction of per capita yearly U.S. health care expenditures.