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Health Maintenance Organization (HMO) Recognition Program
In 2005, the Texas Diabetes Council issued a challenge to HMOs in Texas:
Improve performance on measures of diabetes care in Texas by ten
percent over the next two years.
Acknowledging the impact HMOs have on quality of care for Texans with diabetes, the Council’s HMO Recognition Program invites organizations who surpass the state average for all HEDIS® measures relating to comprehensive diabetes care to be honored at a Council meeting, and appear in listings in Texas Diabetes and on the Council web site.
The Texas Diabetes Council recognized six Texas HMOs for above average, comprehensive diabetes care at its quarterly meeting in Austin on January 26, 2006. Based on a review of data presented in the 2004 Guide to Texas HMO Quality, six HMOs in seven Texas markets exceeded the state average for all six HEDIS® performance measures relating to comprehensive diabetes care in 2003:
Recognized
HMOs |
| · Great-West Healthcare (Dallas) · HMO Blue Texas (Austin and Houston) · Humana Health Plan of San Antonio (San Antonio) · PacifiCare of Texas (San Antonio) · Scott and White Health Plan (Central Texas) · Valley Baptist Health Plan (Harlingen) |
An above average ranking on all six performance measures relating to diabetes care suggests adherence to standards of care for type 1 and type 2 diabetes, a priority area of the Council’s Strategic Plan for 2006 and 2007.
The Health Plan Employer Data and Information Set (HEDIS®) consists of standardized performance measures designed for comparing the quality of care of managed care organizations. This tool is used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Basic service HMOs in Texas with 5,000 or more members are required under Texas law to report HEDIS® measures annually to the Center for Health Statistics, Texas Department of State Health Services.
The six HEDIS® performance measures for comprehensive diabetes care are listed with corresponding state and national averages below:
| Percentage of members 18 through 75 years of age with type 1 or type 2 diabetes using the HMO who . . . | Texas
Average 2003 |
National
Average 2003* |
| had one or more HbA1c tests conducted within the past year. | 79.8% |
84.6% |
| had their most recent HbA1c level greater than 9.5 percent during the past year.** | 46.2% |
32% |
| had an eye screening for diabetic retinal disease within the past year. | 39.4% |
48.8% |
| had their most recent LDL-C level less than 130 mg/dL within the past two years. | 52.6% |
60.4% |
| had a LDL-C test done within the last two years. | 87.7% |
88.4% |
| had screening for nephropathy or evidence of already having nephropathy
within the past year. |
44.4% |
48.2% |
*National averages are presented as goals for the state.
**The Texas Diabetes Council recommends A1c <6.5%. While higher percentages for other diabetes performance measures indicate improved performance, a lower percentage for this measure is favorable.
The Guide to Texas HMO Quality is published each year by the Texas Office of Public Insurance Counsel to aid health plan purchasers and consumers choose plans that best meet their needs.
Last Updated February 27, 2005
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