CCP HEDIS & Star Rating Measures 2 — Questions and Answers
Question 1: Which HEDIS measure tracks the percentage of members with hypertension whose blood pressure was adequately controlled?
- Controlling High Blood Pressure (CBP) (Correct answer)
- Blood Pressure Management Index (BPMI)
- Hypertension Control Rate (HCR)
- Cardiovascular Risk Reduction (CRR)
Correct answer: Controlling High Blood Pressure (CBP)
The Controlling High Blood Pressure (CBP) HEDIS measure tracks the proportion of hypertensive members aged 18–85 with adequately controlled blood pressure.
Question 2: In the CMS Star Ratings system, what rating scale is used to score Medicare Advantage plans?
- 1 to 5 stars (Correct answer)
- A to F grades
- 1 to 10 points
- Bronze to Platinum tiers
Correct answer: 1 to 5 stars
CMS uses a 1-to-5-star scale, with 5 stars representing the highest quality, to rate Medicare Advantage and Part D plans.
Question 3: Which organization is responsible for developing and maintaining HEDIS measures?
- National Committee for Quality Assurance (NCQA) (Correct answer)
- Centers for Medicare & Medicaid Services (CMS)
- Agency for Healthcare Research and Quality (AHRQ)
- Joint Commission on Accreditation (JCAHO)
Correct answer: National Committee for Quality Assurance (NCQA)
HEDIS measures are developed, maintained, and updated annually by the National Committee for Quality Assurance (NCQA).
Question 4: A chronic care professional is reviewing Star Ratings. Which domain category carries the MOST weight in the overall Part C (medical) Star Rating?
- Outcomes measures (Correct answer)
- Patient experience surveys
- Process measures
- Access/availability measures
Correct answer: Outcomes measures
CMS assigns the highest weight to outcomes measures in the Star Rating methodology, recognizing that actual health results are the most important indicator.
Question 5: The HEDIS measure 'Diabetes Care – Eye Exam' captures what specific clinical action?
- Annual retinal or dilated eye exam in diabetic members (Correct answer)
- Visual acuity screening at every clinic visit
- Referral to ophthalmology within 30 days of diagnosis
- Intraocular pressure measurement in diabetic members
Correct answer: Annual retinal or dilated eye exam in diabetic members
This HEDIS measure captures the percentage of diabetic members aged 18–75 who received a retinal or dilated eye exam during the measurement year.
Question 6: What is the primary purpose of the CAHPS survey within the HEDIS reporting framework?
- Capture member-reported experiences with care and service (Correct answer)
- Measure clinical outcomes for chronic disease management
- Assess health plan administrative efficiency
- Track provider credentialing compliance
Correct answer: Capture member-reported experiences with care and service
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collects members' self-reported experiences with care, access, and customer service.
Question 7: Which HEDIS measure assesses appropriate medication management for patients with asthma?
- Medication Management for People with Asthma (MMA) (Correct answer)
- Asthma Adherence Index (AAI)
- Respiratory Drug Utilization Measure (RDUM)
- Inhaler Prescription Compliance Rate (IPCR)
Correct answer: Medication Management for People with Asthma (MMA)
The Medication Management for People with Asthma (MMA) measure evaluates the percentage of asthma patients who were dispensed and remained on controller medications.
CCP HEDIS & Star Rating Measures 2
Which HEDIS measure tracks the percentage of members with hypertension whose blood pressure was adequately controlled?