San Francisco Health Plan: Providers: Improving Quality: HEDIS

Healthcare
Effectiveness
Data & Information Set

San Francisco Health Plan works to promote preventive health care and to improve chronic care for our members. The effectiveness of our efforts are measured by HEDIS, a set of quality improvement indicators set forth by the National Commitee on Quality Assurance (NCQA). SFHP reports performance by a subset of those measures for our Medi-Cal and Healthy Families programs. HEDIS is used to compare health plans both statewide and nationally. The NCQA collects data nationwide and publishes benchmarks. Our goal is to reach the national Medicaid 90th percentile on all measures.

SFHP Recognized As Best Community Health Plan In CA

San Francisco Health Plan Measures

Measure (Click for Description)	Medi-Cal	Healthy Families
Childhood Immunizations	X	X
Well Baby Visits	X	X
Well Child Visits	X	X
Well Adolescent Visits	X	X
Timeliness of Prenatal Care	X
Checkups After Delivery	X
Use of Appropriate Meds for People with Asthma	X	X
Cervical Cancer Screening	X
Breast Cancer Screening	X
Chlamydia Screening		X
Children's Access to Primary Care Practitioners	X	X
Comprehensive Diabetes Care	X
Appropriate Treatment for Children with URI	X
Inappropriate Treatment for Adults with Acute Bronchitis	X

Continuous Enrollment Requirement for All Measures:

For all of the above HEDIS measures there is a continuous enrollment requirement in order to qualify for the measure. The continuous enrollment requirement is usually for the 12 months of the measurement year. For example, for the Well Child Visits measure, the child must be continuously enrolled in the health plan for all of 2005. HEDIS specifications usually allow for one gap in enrollment of up to 45 days.