Quality Improvement Tip Sheets

Quality measures help ensure our members receive appropriate care. We created tip sheets to help you satisfy quality measures, including Healthcare Effectiveness Data and Information Set (HEDIS^®) measures from the National Committee for Quality Assurance.

Complying with these measures may reduce the need for you to provide medical records later for review.

Prevention and Screening

• Breast Cancer Screening 
• Cervical Cancer Screening 
• Childhood Immunization Status 
• Colorectal Cancer Screening 
• Immunizations for Adolescents

Cardiovascular Conditions

• Controlling High Blood Pressure 
• Statin Therapy for Patients With Cardiovascular Disease

Diabetes

• Comprehensive Diabetes Care 
• Comprehensive Diabetes Care: Nephropathy 
• Comprehensive Diabetes Care: Retinal Eye Exam 
• Kidney Health Evaluation for Patients With Diabetes

EPSDT

• EPSDT Services

Mental Health

• Antidepressant Medication Management
• Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications
• First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
• Follow-Up After High-Intensity Care for Substance Use Disorder
• Follow-Up Care for Children Prescribed ADHD Medication
• Follow-Up After Hospitalization for Mental Illness
• Follow-Up After Emergency Department Visit for Mental Illness
• Metabolic Monitoring for Children and Adolescents on Antipsychotics
• Pharmacotherapy for Opioid Use Disorder
• Prenatal and Postpartum Depression Screening and Follow-Up

Preventive Care

• Preventive Care Guidelines for Adults
• Preventive Care Guidelines for Children

Substance Use

• Follow-Up After Emergency Department Visit for Substance Use
• Initiation and Engagement of Substance Use Disorder Treatment
• Use of Opioids From Multiple Providers

Access/Availability of Care

• Prenatal and Postpartum Care

Overuse/Appropriateness

• Appropriate Treatment for Upper Respiratory Infection 
• Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis 
• Use of Imaging Studies for Low Back Pain

Utilization and Risk Adjusted Utilization

• Child and Adolescent Well-Care Visits

_{The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.}

_{HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here .}