New format combines four areas of focus


In an effort to streamline mailings to providers, Providence Health Plan has created a new format that combines several of the gap-in-care reports, previously sent separately. The new combined report encompasses three familiar reports and one new area of focus.

Providence Health Plan’s quality programs use Healthcare Effectiveness Data and Information Set, or HEDIS, criteria to determine patient compliance with recommended care. HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.

The four areas of focus, based on our HEDIS results, are those that are of primary concern and for which our members could benefit from provider follow-up:

  • Chlamydia: preventive screening in women ages 16 to 24 who are identified as potentially sexually active, based on pharmacy and claims/encounter data
  • Chronic obstructive pulmonary disease, or COPD: spirometry testing to confirm new diagnosis of COPD
  • Diabetes: LDL and HbA1c screening/values above 100 mg/dL and 7 percent, respectively
  • Asthma medication management: short- to long-term medication use

A cover letter explaining the intent of the report and request for follow-up will accompany a list of your Providence Health Plan patients’ who appear to have a gap in care in one or more of the above areas, based on claims data.

For providers who see 50 or more Providence Health Plan patients annually, additional quality data and disease registry information is available via an electronic quality profile through ProvLink. Your profile contains additional disease registry lists for a variety of quality measures (HEDIS and non-HEDIS measures).