TRICARE Senior Prime HEDIS Medicare Reporting: Exploring the Information Quality Model

Abstract

Abstract : The use of the Health Plan Employer Data and Information Set (HEDIS) 3.0 provides the Military Health System (MHS) with a platform to demonstrate its strengths in delivering quality managed care to dual-eligible Medicare/Department of Defense (DoD) beneficiaries and to locate areas for improvement. The MHS is tasked with reporting 22 HEDIS Medicare measures to the Health Care Financing Administration (HCFA) to comply with the TRICARE Senior Prime (TSP) demonstration guidelines. This study reports on the current information model used by the MHS to collect one of these measures: Beta Blocker Treatment After a Heart Attack. The current information model used by the MHS was found insufficient to allow for administrative reporting of the targeted measure. The study formulated an alternative conceptual information model based upon the fundamentals of Total Data Quality Management (TDQM). The two models were evaluated utilizing Wang's dimensions of information quality. The alternative conceptual model was found to be vastly superior to the current information model in every dimension. The concepts used to formulate the conceptual model, if applied, would allow the MHS to develop an effective information management system for the TSP demonstration.