WHA reports three Healthcare Effectiveness Data and Information Set (HEDIS) preventive health screening measures for women.
- Breast Cancer Screening (BCS) measure assesses women 50-74 years of age who had one mammogram to screen for breast cancer in the past two years.
- Cervical Cancer Screening (CCS) measure assesses women who were screened for cervical cancer using any of the following criteria:
- Women 21–64 years of age who had cervical cytology performed within the last 3 years.
- Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
- Women 30–64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years.
- Chlamydia Screening (CHL) measure assesses the percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.
- Osteoporosis Screening (OSW) measure assess women 65-75 years of age who received osteoporosis screening.
WHA’s HEDIS Screening Rates:
|
COMMERCIAL - PREVENTIVE HEALTH SCREENINGS FOR WOMEN
|
WHA MY2021
|
WHA MY2022
|
WHA MY2023
|
WHA NCQA PERCENTILE RANK MY2023
|
NCQA MY2023 90TH PERCENTILE RANK GOAL
|
|---|---|---|---|---|---|
|
Breast Cancer Screening
|
75.44
|
79.23
|
83.87
|
>95th
|
81.6
|
|
Cervical Cancer Screening
|
68.58
|
61.31
|
65.31
|
67th
|
71.37
|
|
Chlamydia Screening
|
61.6
|
61.12
|
59.79
|
75th
|
66.33
|
|
MEDICARE ADVANTAGE -
PREVENTIVE HEALTH SCREENINGS FOR WOMEN |
WHA MY2021*
|
WHA
MY2022 |
WHA MY2023 |
WHA CMS STAR RATE
|
CMS 5 STAR RATE
|
|---|---|---|---|---|---|
|
Breast Cancer Screening
|
80.85
|
84.15
|
83.43 |
5
|
>77
|
|
Osteoporosis Screening in Older Women 65-75 years
|
45.67
|
83.33
|
56.25 |
3
|
>73
|
- MY2021 first year reporting Medicare Advantage
|
EXCHANGE -
PREVENTIVE HEALTH SCREENINGS FOR WOMEN |
WHA MY2021
|
WHA MY2022
|
WHA MY2023
|
WHA
CMS QHP RATE |
|---|---|---|---|---|
|
Breast Cancer Screening
|
63.18
|
70.37
|
73.73
|
50th
|
|
Cervical Cancer Screening
|
56.93
|
63.03
|
61.98
|
50th
|
|
Chlamydia Screening
|
44.44
|
46.76
|
49.67
|
50th
|
Potential barriers that contribute to decreased preventive health screenings include;
Lack of provider recommendation for regular cervical cancer screening. EHR Health Maintenance lists not including alerts prior to due dates. No process for timely reminders to patients. Standing orders or automatic ordering, such as for chlamydia screening with cervical cytology for females 16-24, may be disrupted. Lack of systems/processes to identify patients who need screening and staff resources for outreach to those patients. Delayed access for mammograms and/or well-woman exams. Lack of patient education materials in the provider office. Public debate of the guidelines has contributed to patient confusion regarding screening recommendations as to appropriate age and frequency of screenings.
In MY2025 NCQA will be transitioning Cervical Cancer Screening to electronic clinical data systems (ECDS) and will no longer allow chart pulls during HEDIS season.
Uscher, J. (2024, October 18). When to get a mammogram. Breastcancer.org - Breast Cancer Information and Support. https://www.breastcancer.org/screening-testing/mammograms/recommendations
Curtis, A. (2024, October 3). USPSTF releases New Breast Cancer Screening Guidelines. Breastcancer.org - Breast Cancer Information and Support. https://www.breastcancer.org/news/new-screening-guidelines-USPSTF
Cervical cancer screening. NCI. (n.d.). https://www.cancer.gov/types/cervical/screening
Chlamydia screening in women - NCQA. (n.d.). https://www.ncqa.org/hedis/measures/chlamydia-screening-in-women/
US Preventive Services Taskforce. (2024, June 11). Osteoporosis to prevent fractures: Screening. Draft Recommendation: Osteoporosis to Prevent Fractures: Screening | United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/osteoporosis-screening-prevent-fractures
Last review date: December 5, 2024