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Health Outcomes Reports

Sunflower Health Plan earned Health Outcomes Accreditation in 2023 through the National Committee for Quality Assurance (NCQA). NCQA Health Outcomes accreditation gives healthcare organizations an actionable framework for improving health equity. NCQA provides Standards and Guidelines for Health Outcomes Accreditation. Here the Standards for Health Outcomes that must be maintained for our accreditation status:

HO 1: Organizational Readiness

  • Element A: Trainings to Improve Care or Service Delivery

HO 2: Collecting Member- or Patient-Level Data

  • Element A: Collection of Data on Race and Ethnicity
  • Element B: Collection of Data on Language
  • Element C: Collection of Data on Sexual Orientation
  • Element D: Collection of Data on Disability Status
  • Element E: Collection of Data on Disability-Related Accommodations
  • Element F: Classification of Geographic Data
  • Element G: Evidence of Data Collection or Classification
  • Element H: Systems for Member- or Patient-Level Data
  • Element I: Privacy Protections for Demographic Data
  • Element J: Notification of Demographic Data Privacy Protections

HO 3: Access and Availability of Language Services

  • Element A: Written Documents
  • Element B: Spoken Language Services
  • Element C: Support for Language Services
  • Element D: Notification of Language Services

HO 4: Access and Availability of Disability Accommodations

  • Element A: Availability of Disability Accommodations
  • Element B: Care Delivery Supports for Disability Accommodations
  • Element C: Health Plan Supports for Disability Accommodations
  • Element D: Accessible Digital Content

HO 5: Practitioner Network and Care Site Responsiveness

  • Element A: Practitioner and Site-Level Information
  • Element B: Availability of Information on Practitioners and Care Sites
  • Element C: Enhancing Network Responsiveness
  • Element D: Information on Accessible Equipment
  • Element E: Enhancing Care Site Accessibility

HO 6: Program to Improve Service Appropriateness and Accessibility

  • Element A: Program Description
  • Element B: Annual Evaluation

HO 7: Reducing Health Care Disparities

  • Element A: Reporting Stratified Measures
  • Element B: Stratifying Measures to Assess Disparities
  • Element C: Use of Data to Monitor and Assess Services
  • Element D: Use of Data to Measure CLAS and Disparities

On an annual basis, we report and analyze four Healthcare Effectiveness Data and Information Set (HEDIS®) measures, stratified by race and ethnicity, to determine whether disparities in health care access, quality or outcomes exist among our Medicaid members. Stratifying these measures allows us to move beyond aggregate performance and identify inequities that may otherwise remain hidden.

The findings inform our ongoing quality improvement initiatives and help ensure accountability, transparency and sustained action toward eliminating health disparities and improving health outcomes for all members.

What is HEDIS®?

HEDIS® (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to objectively measure, report, and compare quality across health plans. NCQA develops HEDIS® measures through a committee represented by purchasers, consumers, health plans, healthcare providers, and policy makers.

What are the scores used for?

As state and federal governments move toward a quality-driven healthcare industry, HEDIS® rates are becoming more important for both health plans and individual providers. State purchasers of healthcare use aggregated HEDIS® rates to evaluate health insurance companies’ efforts to improve preventive health outreach for members.

Each quarter, we will publish the most current stratified data here to share our progress.

Health Outcomes Report Cards

MetricDefinitionExample
HEI IndHealth Equity Index Indicator1=Yes, 0=No
LOBLine of BusinessMedicaid/Medicare/Market Place
Measure YearMeasurement Year for the HEDIS rate calculations 
Plan RatePlan Measure RatePlan Submeasure Numer/Plan submeasure Denom
Plan NameQSI Reporting Population NameAR_MD
Race/Ethnicity SourceSource database, or the analysis procedure used to derive patient race and ethnicityCMS/STATE/GEO-CODING/HEALTH PLAN DIRECT
RateSubmeasure Numer/Submeasure Denom 
ZscoreThe number of standard deviations a value is from the mean.(Submeasure rate - Mean rate/ (STD.P submeasure Rate)
DisparityThe percent variance of a specific member demographic HEDIS Rate when compared to the top performing (Highest rate and denom >30) member demographic.SubMeas/Member Demographic HEDIS Rate- Top Performing SubMeas/Member Demographic HEDIS Rate
New RateThis metric calculates a new plan measure rate by adding the remainder to the plan measure numerator.Remainder + Plan Measure Numer/Plan Measure Denom
RemainderThis metric calculates the actual sub-measure numerator hits under the expected sub-measure numerator hits based on the plan level HEDIS rate.(Submeas Denom * Plan Level Rate)- SubMeas Number = Remainder
Impact LiftThis metric calculates the expected HEDIS Rate increas if the associated member demopgraphic reached the Benchmark Rate.New Rate - Benchmark Rate
Reference GroupTop performing group for the selected plan/submeasure with a denominator >=30. 
DenomUnique members that have met the criteria to be included in the denominator of an associated measure and sub-measure. 
NumerUnique members that are compliant with the requirements for an associated measure and sub-measure