HJBR Nov/Dec 2023

HEALTHCARE JOURNAL OF BATON ROUGE  I  NOV / DEC 2023 49 Yolanda E. Wilson, MSN, RN, CPHQ Senior Vice President of Quality Louisiana Healthcare Connections als, and, ideally, will refine approaches to racial, ethnic, and gender identity data. Improved child well care A study published by researchers with Johns Hopkins Children’s Center and the Kennedy Krieger Institutes shows that well-care visits are very important for a healthy transition from childhood to ado- lescence. A focus for Louisiana at the out- set of the managed care transition, adoles- cent wellness measures have seen positive trends overall. Well-child visits (1st 15 months) alone have improved 47.58% since 2011, and childhood immunization status (CIS 2) improved by 57.75%. And even though HEDIS has shifted to newer measures, they are also showing improve- ment since being “relaunched” in 2021. Addressing health disparities Irregular data collection related to race, ethnicity, and sexual orientation/gender identity (SOGI) can make it difficult to identify disparities, mitigating the ability to provide intervention where it is needed most, so NCQA has added race and eth- nicity layers to eight HEDIS measures. The organization has also pledged to explore methods that incorporate racial, ethnic, and SOGI data in more detail so that ap- propriate care is built on accuracy and clarity. Broader, more comprehensive eli- gibility criteria will also help ensure every- one who needs care gets care. In addition, a new measure that gauges social need screenings and interventions (SNS-E) will assess who received screen- ings for unmet social and economic needs, such as food, housing, and transportation. Health plans and providers will also be measured on whether these individuals re- ceived a corresponding intervention if they needed help in one or all of these areas. For oral health, access to high-quality pediatric dental care represents a source of anxiety for most patients, especially for Medicaid recipients. While all children on Medicaid are entitled to dental services, less than half receive regular care from a dentist. Topical fluoride varnish in children aged 1-4 years old has been related to few- er cavities and better overall oral health in young children, and, starting in 2023, HEDIS began measuring the rate of its ap- plication along with comprehensive or pe- riodic oral care evaluations among pedi- atric Medicaid members. In support of the measure and its positive outcomes, MCOs have all committed to promoting fluoride varnish to both their providers and to their members. Plan performance over the years In Louisiana, the performance of Med- icaid managed care organizations (MCOs) is monitored using a range of quality measures that includes both HEDIS and non-HEDIS metrics. Ultimately, valid re- porting relies on accurate and compliant data derived through rigorous coding standards. And without the enhanced time, effort, and attention of clinicians and ad- ministrators, it would not be possible. But missing or non-compliant data happens, and that means some reported measure outcomes may show care gaps instead of data gaps. Over the twelve years since Louisiana adopted a managed care mod- el, some measures have been added and others have been retired, making it diffi- cult to paint a holistic and accurate pic- ture of year-over-year, apples-to-apples improvements. Moreover, tracking differ- ent measures began in different years, fur- ther complicating the ability to establish a baseline starting point. However, since 2011, Medicaid managed care has made positive gains in process measures overall, and in the ongoing pursuit of meaningful continuous improvement, they merit high- lighting and sharing. n REFERENCES HealthViewX. “HEDIS: Healthcare Effectiveness Data and Informaiton Set.” Accessed Septem- ber 2023. www.healthviewx.com/hedis-health- care-effectiveness-data-and-information-set/ May, D. “Why You Should Take Heed of HEDIS.” Verinovum, April 13, 2023. https://verinovum. com/2023/04/take-heed-of-hedis/ Noshay, M. “The Real Cost of CMS Star Ratings.” Verinovum, April 29, 2023. https://verinovum. com/2023/04/the-real-cost-of-cms-star-rat- ings/ McIntyre, D.; Roges, L.; Heier, E.J. “Overview, His- tory, and Objectives of Performance Measure- ment.” Health Care Financing Review 22, no. 3 (Spring 2001): 7-21. www.ncbi.nlm.nih.gov/pmc/ articles/PMC4194707/ Sarasogn-Kahn, J. “Bolstering Health Equi- ty Through the Right Data: Welcome to HE- DIS 2023.” Medecision, Feb. 21, 2023. https:// blog.medecision.com/bolstering-health-equi- ty-through-data/#:~:text=In%20applying%20 stratification%20to%20the,to%20address%20 the%20care%20gaps Blount, W. “Research Story Tip: Well-Care Visits Promote Better Health During Transition from Childhood to Adolescence.” Johns Hopkins Med- icine. News release, April 28, 2021. www.hopkins- medicine.org/news/newsroom/news-releases/ research-story-tip-well-care-visits-promote-bet- ter-health-during-transition-from-childhood-to- adolescence Bresnick, J. “Health equity takes center stage with new HEDIS quality measures.” Digital Health Insights, April 9, 2022. www.dhinsights.org/ news/health-equity-takes-center-stage-with- new-hedis-quality-measures Parente, L. “High-Quality Clinical Data Has the Potential to Transform HEDIS Quality Report- ing and Close Care Gaps.” Availity July 12, 2023. www.availity.com/blog/2023/july/transform-he- dis-quality-reporting-and-close-care-gaps As senior vice president of quality,Yolanda E.Wilson oversees quality and performance improvement ini- tiatives centered on improving the quality of care and services provided to plan members, including NCQAcompliance,health plan accreditation,HEDIS performance, member satisfaction, and grievance and appeal functions.She is responsible for program development,design,outcomesmeasurement,and evaluation of the quality program to ensure align- ment with state contracting requirements and CMS and NCQAguidelines.Prior to her role with Louisiana Healthcare Connections,Wilson served severalTexas health system,s managing their quality and compli- ance. She also served as an adjunct professor with the University of Texas College of Nursing.