January 2020
2019 HEDIS® Results for Medicaid Children and Adolescent Immunization
Healthcare Effectiveness Data and Information Set (HEDIS) is a nationally standardized set of measures related to important areas of care and service in the health care field. Developed by the National Committee for Quality Assurance (NCQA),1 HEDIS is one of the most widely used set of health care performance measures in the U.S.
According to the 2019 HEDIS rates for Blue Cross Community Health PlansSM (BCCHPSM) members, the childhood immunization measure, Combo 3 and Combo 10 are improving but fell short of the 75th percentile goal. The adolescent immunization measure, Combo 1 met the benchmark, however Combo 2 did not meet the benchmark.2 Proper documentation is crucial to ensure vaccinations are recorded correctly.
Childhood Immunization Status (CIS)
- Combo 3: 2019 HEDIS Goal = 75.91%
- 2019 HEDIS rate = 73.72%
- 2018 HEDIS rate = 68.13%
- 2017 HEDIS rate = 66.67%
- Combo 10: 2019 HEDIS Goal = 41.00%
- 2019 HEDIS rate= 38.20%
- 2018 HEDIS rate =36.01%
- 2017 HEDIS rate=29.63%
Immunizations for Adolescents (IMA)
- Combo 1: 2019 HEDIS Goal = 83.89%
- 2019 HEDIS rate = 85.40%
- 2018 HEDIS rate = 80.78%
- Combo 2: 2019 HEDIS Goal = 38.00%
- 2019 HEDIS rate = 37.23%
- 2018 HEDIS rate = 33.82%
As part of the health care team, doctors, practitioners and nurses play a vital role in improving the HEDIS rates. You can help by educating parents and encouraging them to vaccinate their children. Equally important is the proper documentation of the immunizations given, such as documenting all Combos correctly. Below are a few tips you may choose to apply:
- Communicate with parents regarding the benefits of age appropriate childhood immunization
- Explain the pros and cons of immunizations
- Allow the parents to express their concerns
To further your discussion, below are the HEDIS measures for CIS and IMA.
CIS: Combo 3 includes the below vaccinations. It is recommended children receive them by their second birthday.2
- Four diphtheria, tetanus and acellular pertussis (DTaP)
- Three polio (IPV)
- One measles, mumps and rubella (MMR)
- Three haemophilus influenza type B (HiB)
- Three hepatitis B (HepB)
- One chicken pox (VZV)
- Four pneumococcal conjugate (PCV)
CIS: Combo 10 includes Combo 3 plus three additional vaccinations. It is recommended children receive them by their second birthday.2
- Four diphtheria, tetanus and acellular pertussis (DTaP)
- Three polio (IPV)
- One measles, mumps and rubella (MMR)
- Three haemophilus influenza type B (HiB)
- Three hepatitis B (HepB)
- One chicken pox (VZV)
- Four pneumococcal conjugate (PCV)
- One hepatitis A (HepA)
- Two or three rotavirus (RV)
- Two influenza (Flu) vaccines
IMA: HEDIS measures assess adolescents 13 years of age who had the following immunizations by age 13:3
Combo 1
- One dose of meningococcal vaccine (between ages 11 to 13 years)
- One Tdap vaccine (between ages 10 to 13 years)
Combo 2
- One dose of meningococcal vaccine;
- One Tdap vaccine; and
- The complete human papillomavirus vaccine series between 9 to 13 years of age
- Two-dose Series: must be at least 146 days between the first and second doses
- Three-dose Series: If three vaccines with different date of service.
For additional information on recommended immunization schedule for children and adolescents aged 18 years or younger, review our Preventive Care Guidelines.
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
1 NCQA, HEDIS and performance measures, 2019. Retrieved from: https://www.ncqa.org/hedis/
2 NCQA, Childhood Immunization Status (CIS), 2019. Retrieved from https://www.ncqa.org/hedis/measures/childhood-immunization-status/
3 CDC, Vaccines for Your Children, 2019. Retrieved from https://www.cdc.gov/vaccines/parents/index.html
The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.