08-03-2023_BoardBook

diagnoses, procedures, admission status, discharge, length of stay, and charges. Among all the hospital

care quality programs, there are no (zero) reported obesity specific or weight related quality measures.

Health Insurance Plan Quality Measures

Health insurance plans report on a combination of clinical quality measures and health plan

members’ experiences with care (AHRQ M. i., 2018). Annually, health insurance plans are required to

report out using two main datasets, the Healthcare Effectiveness Data and Information Set (HEDIS),

which includes the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. HEDIS is

the most common set of health care performance measures used by both public and private health

insurance plans. The National Committee for Quality Assurance (NCQA) collects Medicare and Exchange

data on behalf of CMS, Medicaid HEDIS data on behalf of state agencies, and commercial health

insurance plan data on behalf of states and the federal government employees under the U.S. Office of

Personnel Management (NCQA, HEDIS Data Submission, 2022).

HEDIS collects data on more than 90 quality measures across six domains of care, which are

effectiveness of care, access or availability of care, experience of care, utilization and risk adjusted

utilization, health plan descriptive information, and measures reported using electronic clinical data

systems (NCQA, HEDIS Measures, 2022). Under the effectiveness of care domain of HEDIS, there is one

obesity specific measure for prevention and screening: Weight Assessment and Counseling for Nutrition

and Physical Activity for Children/Adolescents. This measure is described in full below. While it is

encouraging to see an obesity measure included in the HEDIS measure set, it is a process measure that

only captures obesity prevalence among the reporting plans. Furthermore, it is limited to only

nutritional counseling in children and adolescents and does not report on health assessment or

treatment outcomes for children and adolescents or adults, or other aspects of care delivery.

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