Preventive care measures in HEDIS are designed to ensure that patients receive essential screenings and vaccinations that can help detect and prevent serious health conditions. These measures cover a wide range of health issues and are crucial for maintaining overall health and well-being.

Below is an overview of just a few of the HEDIS quality measures that are included in BCBSRI’s PCP Quality Incentive Program (PQIP), but please note that this list does not include every PQIP quality measure:

1. Breast Cancer Screening (BCS): This measure assesses the percentage of women aged 50-74 who have had a mammogram within the past two years. Regular mammograms are vital for early detection of breast cancer, which can significantly improve treatment outcomes. Mammograms are normally covered at no cost to the member.
2. Colorectal Cancer Screening (COL-E): This measure evaluates the percentage of adults aged 50-75 who have had appropriate screening for colorectal cancer. Screenings can include colonoscopy, sigmoidoscopy, or fecal occult blood tests. Early detection of colorectal cancer can lead to more effective treatment and better survival rates. Colorectal cancer screening is normally covered at no cost to the member.
3. Osteoporosis Management in Women Who Had a Fracture(OMW): This measure is an important component of HEDIS. This measure tracks the percentage of women aged 67-85 who have experienced a fracture and subsequently received appropriate osteoporosis management. Specifically, it assesses whether these women have undergone a bone mineral density (BMD) test or received a prescription to treat or prevent osteoporosis within six months of the fracture. An additional approach to improving performance in this measure is to broadly screen all women aged 65-85 for osteoporosis.
4. Chlamydia Screening in Women: This measure evaluates the percentage of sexually active women aged 16-24 who have been screened for chlamydia. Early detection and treatment of chlamydia can prevent serious reproductive health complications. Conversations with parents and adolescent patients can be difficult surrounding this measure, but it is important to remind patients that this screening is a normal, routine part of their preventive healthcare.

These preventive care measures are critical components of HEDIS and play a significant role in promoting high-quality healthcare. By ensuring that patients receive these essential screenings, healthcare providers can help prevent serious health conditions and improve overall health outcomes. We would love to hear from your practice on current quality initiatives and opportunities for partnership with BCBSRI.

If you have any questions on the PQIP Program, quality management, or would like further details, please contact the BCBSRI Quality Concierge Team at QualityHEDIS@bcbsri.org. We are always available to answer questions.