Hybrid HEDIS Measures

The table below includes "hybrid" Healthcare Effectiveness Data and Information Set (HEDIS®)1 measures. Hybrid measures are measures in which additional information in the medical chart may be sought to complement claims data in order to provide a full picture of the care/services provided. Although chart abstractors will be the ones completing the search for this information, PrimeWest Health is providing this table for your information.

Measure Documentation of Care Needed
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC); ages 3 – 17 Medical records for these members must include height, weight, and body mass index (BMI) percentile. Counseling regarding nutrition and physical activity is to be completed annually.
Care for Older Adults (COA); ages 66 and over Evidence of the following during the measurement year:
  • Medication review: At least one medication review conducted by a prescribing practitioner or clinical pharmacist during the measurement year and the presence of a medication list in the medical record
  • Functional status assessment: Notation that instrumental activities of daily living (IADLs) were assessed (includes shopping for groceries, driving or using public transportation, using the telephone, meal preparation, housework), or notation that activities of daily living (ADLs) were assessed (includes bathing, dressing, toileting), or the result of assessment using a standardized functional status assessment tool
Prenatal and Postpartum Care (PPC)
  • Prenatal visit within 1st trimester or within 42 days of enrollment
  • Postpartum visit between 7 and 84 days after delivery
Controlling High Blood Pressure (CBP); ages 18 – 85 Evidence of a diagnosis of hypertension in medical record during first 6 months of measurement year. The most recent blood pressure reading during the measurement year where control <140/90 mm Hg.
Glycemic Status Assessment for Patients with Diabetes (GSD)

Evidence of the following in the medical record each year:

  • HbA1c results (measures both under 8 and over 9)
  • Continuous glucose monitoring results using a Dexcom or other glucose monitoring indicator device
Blood Pressure Control for Patients with Diabetes (BPD) Evidence of the following in the medical record each year:
  • Blood pressure control <140/90 mm Hg
Transitions of Care (TRC); ages 18 and over, Special Needs Plan (SNP) members Evidence of all of the following for members discharged from the hospital:
  • Notification of inpatient admission: Documentation of inpatient admission on the day of or the day following admission
  • Receipt of discharge information: Documentation of discharge information on the day of or the day following discharge
  • Patient engagement: Evidence patient engagement was provided within 30 days of discharge (follow-up visit, telehealth, home visit, etc.)
  • Medication reconciliation: Evidence medication reconciliation completed within 30 days of discharge

 

1HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

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Updated_07/11/2025