The Significant Impact of Different Insurance Enrollment Criteria on the HEDIS Chlamydia Screening Measure for Young Women Enrolled in Medicaid and Commercial Insurance Plans

Abstract

The large proportion of young women who had a 2-month or greater gap in coverage in Medicaid had a significant impact on the overall representativeness of the current HEDIS chlamydia screening measure.

National Chlamydia Screening Rate in Young Sexually Active Women Using HEDIS Measures in the United States, 2011 to 2020

“…First, HEDIS data are based on convenience samples and do not represent the entire population of the United States; the patients enrolled in the health plans that report to HEDIS may not be representative of all patients in the United States. Furthermore, HEDIS measurement criteria are restrictive and can exclude many patients, such as significant percentages of young sexually active women who were excluded because of gaps in healthcare coverage or no sexual-related claims 18 . Second, chlamydia screening rates were determined by using the increased denominators from 2011 to 2020 in both commercial and Medicaid health plans.…”

“…Furthermore, HEDIS measurement criteria are restrictive and can exclude many patients, such as significant percentages of young sexually active women who were excluded because of gaps in healthcare coverage or no sexual-related claims. 18 Second, chlamydia screening rates were determined by using the increased denominators from 2011 to 2020 in both commercial and Medicaid health plans. Third, the HEDIS sample of sexually active women aged 16 to 24 years may not be representative of all members of that demographic.…”

Continuous Eligibility for Medicaid Associated With Improved Child Health Outcomes

“…Many children who lose Medicaid end up reapplying and regaining coverage quickly (Simon & Schoendorf, 2014), adding burden to state eligibility systems. Short periods of Medicaid coverage also impede quality measurement, which limits the viability of value-based payment strategies that link payment to managed care companies or providers to health outcomes (Mann, 2018; Patel & Tao, 2015).…”

Young Adults’ Access to Insurance Through Parents: Relationship to Receipt of Reproductive Health Services and Chlamydia Testing, 2007–2014

“…Data come from a selection of large employers and commercial health plans. It may not reflect the general population in the United States or the general population of insured individuals as many individuals are not insured for a minimum of 330 days in a calendar year; likewise, there is some amount of churn in the plans participating in the MarketScan database yearly [29]. Findings may not be applicable to individuals covered by Medicaid or Medicare.…”