HEDIS Information

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Molina Healthcare of Florida uses the Healthcare Effectiveness Data and Information Set (HEDIS®) tool each year as a way to measure quality. This is done by looking at the type of care and services provided. HEDIS® is maintained by the National Committee for Quality Assurance (NCQA). This allows the review of certain aspects of care. This includes clinical and non-clinical care. It also shows where plans can improve care and service. Molina’s goal is to be better than 75% of other Medicaid health plans in the nation.

Molina’s scores for the past two years are below. You can see how Molina performs compared to our target goal.

 

Measure

2023

Rate

2023

Goal

2024

Rate

2024 Goal

Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)

63.58%

64.90%

66.79%

66.15%

Annual Dental Visits (ADV) Total

NB

54.60%

 

 

Antidepressant Medication Management (AMM) Effective Continuation Phase Treatment

42.63%

46.74%

39.09%

48.16%

Appropriate Testing for Pharyngitis (CWP)

65.69%

77.56%

77.62%

85.11%

Appropriate Treatment for Upper Respiratory Infection (URI) Total

91.42%

93.08%

89.75%

91.27%

Asthma Medication Ratio (AMR) Total

79.69%

69.41%

79.75%

70.56%

Avoidance of Antibiotic Treatment for Acute Bronchitis / Bronchiolitis (AAB)

65.53%

66.19%

64.55%

67.03%

Blood Pressure Control (<140/90) for Patients With Diabetes (BPD)

68.61%

68.61%

62.04%

71.78%

Breast Cancer Screening (BCS)

60.96%

55.25%

 

 

Breast Cancer Screening (BCS-E)

60.58%

54.94%

60.13%

56.66%

Cervical Cancer Screening (CCS)

64.72%

59.85%

62.04%

60.10%

Childhood Immunization Status (CIS) Combination #10

33.84%

35.04%

35.28%

31.32%

Chlamydia Screening in Women (CHL) Total

62.88%

61.07%

65.75%

61.46%

Controlling High Blood Pressure (CBP)

71.29%

65.45%

64.48%

67.40%

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)

82.27%

80.86%

83.62%

83.51%

Eye Exam for Patients With Diabetes (EED)

49.15%

56.20%

48.91%

57.09%

Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA) 7-Day Follow-Up Total

19.64%

27.73%

12.14%

27.62%

Follow-Up After Emergency Department Visit for Mental Illness (FUM) 7-Day Follow-Up Total

30.95%

46.35%

37.50%

44.33%

Follow-Up After Hospitalization for Mental Illness (FUH) 7-Day Follow-Up Total

31.99%

41.03%

32.51%

42.86%

Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) 7-Day Follow-Up Total

18.46%

37.31%

24.07%

37.64%

Follow-Up for Children Prescribed ADHD Medication (ADD) Continuation and Maintenance Phase

62.34%

57.90%

61.54%

56.86%

Follow-Up for Children Prescribed ADHD Medication (ADD-E) Continuation and Maintenance Phase

 

 

61.54%

56.83%

Hemoglobin A1c Control for Patients With Diabetes (HBD) HbA1c Control (<8%)

53.53%

55.72%

49.39%

59.64%

Immunizations for Adolescents (IMA) Combination #2

43.07%

38.93%

40.88%

38.69%

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) Engagement of AOD Treatment Total

7.54%

16.94%

7.44%

16.78%

Kidney Health Evaluation for Patients with Diabetes (KED)

43.76%

38.80%

46.99%

42.10%

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) Blood Glucose and Cholesterol Testing Total

34.67%

39.01%

39.90%

41.92%

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E) Blood Glucose and Cholesterol Testing Total

 

 

39.90%

41.41%

Pharmacotherapy for Opioid Use Disorder (POD) Total

10.07%

31.93%

6.33%

29.01%

Pharmacotherapy Management of COPD Exacerbation (PCE) Systemic Corticosteroids

59.35%

75.79%

63.48%

74.78%

Pharmacotherapy Management of COPD Exacerbation (PCE) Bronchodilator

83.74%

86.96%

80.87%

86.54%

Plan All-Cause Readmissions (PCR) Observed-to-Expected Ratio 18-64 Years

101.87%

≤ 92.72%

92.32%

≤ 91.24%

Prenatal and Postpartum Care (PPC) Timeliness of Prenatal Care

86.37%

86.86%

80.05%

86.89%

Prenatal and Postpartum Care (PPC) Postpartum Care

78.10%

80.78%

76.89%

82.48%

Prenatal Immunization Status (PRS) Combination Rate

8.19%

25.81%

 

 

Prenatal Immunization Status (PRS-E) Combination Rate

8.19%

25.81%

9.91%

24.92%

Risk of Continued Opioid Use (COU) 31-Day Total

1.95%

≤ 2.45%

2.01%

≤ 2.79%

Statin Therapy for Patients with Cardiovascular Disease (SPC) Received Statin Therapy Total

81.46%

81.64%

82.43%

83.00%

Statin Therapy for Patients with Cardiovascular Disease (SPC) Statin Adherence 80% Total

54.48%

73.63%

62.70%

74.07%

Statin Therapy for Patients with Diabetes (SPD)

Received Statin Therapy

70.16%

67.07%

70.79%

67.01%

Statin Therapy for Patients with Diabetes (SPD)

Statin Adherence 80%

49.10%

70.37%

56.69%

70.91%

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) Total

77.50%

63.89%

70.94%

64.10%

Use of Imaging Studies for Low Back Pain (LBP)

64.30%

75.44%

64.61%

72.74%

Use of Opioids at High Dosage (HDO)

10.70%

≤ 2.19%

9.88%

≤ 2.14%

Use of Opioids from Multiple Providers (UOP)

Multiple Prescribers and Multiple Pharmacies

1.11%

≤ 0.87%

1.36%

≤ 1.22%

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) BMI Percentile

84.91%

83.21%

88.08%

86.20%

The reporting year is subsequent of the year reflected in the data; for example, “HEDIS 2023” is data collected from calendar year January-December 2022.

NA = Not Available Due to Small Denominator         

NB = No Benefit

NR = Not Reported

NQ = Not Required

BR = Biased Rate

If you have questions or would like additional information about HEDIS®, please contact Molina Healthcare of FL Quality Department at (866) 472-4585 (TTY: 711). You may request printed copies of all content posted on our website by calling the Member Services number on your member ID card.

HEDIS® is a Registered Trademark of the National Committee for Quality Assurance.