Be a HEDIS HERO for your pregnant patients

The National Committee for Quality Assurance (NCQA) is a non-profit organization that measures the quality of healthcare across large populations. NCQA does this through its Health Effectiveness and Data Set, also known as HEDIS. HEDIS ‘Measures’ are a set of evidence based standards that Texas Children’s Health Plan is committed to improving upon in order to provide the best care for our members.

Making changes across your patient population is easier than you think! In fact, you can become a HEDIS HERO by simply providing prenatal care and postpartum care in a timely manner.

The HEDIS Prenatal and Postpartum Care Timeliness metrics measure the percentage of women who had a live birth and received a prenatal care visit during their first trimester of pregnancy or within 42 days of enrollment with TCHP.

Tips for being a prenatal HEDIS hero:

• Include all the required documentation in the medical record for PRENATAL care visit:
  • A basic physical obstetrical examination that includes auscultation for fetal heart tones, pelvic exam with obstetric observations, or measurement of fundal height (a standardized prenatal flow sheet may be used)
  • Prenatal Care Procedure such as screening tests/obstetric panel, TORCH antibody panel alone, rubella antibody test/titer with a Rh incompatibility (ABO/Rh) blood typing, or Ultrasound/Echography of a pregnant uterus
  • Documentation of LMP or EDD with either prenatal risk assessment & counseling/education, or complete obstetrical history
• Schedule prenatal care visits starting in the first trimester or within 42 days of enrollment
• Ask your front office staff to prioritize new pregnant patients and ensure prompt appointments for any patient calling for a pregnancy visit. High-risk pregnancies or new members in their third trimester should have appointments offered within 5 days of request.  Routine pregnancies should be offered an appointment within 14 days of request.  Any patient with an emergency should be offered an appointment immediately.