Adults' access to preventive/ambulatory health services: percentage of members 20 years and older who had an ambulatory or preventive care visit.

This measure is used to assess the percentage of members 20 years and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each product line:

• Medicaid and Medicare members who had an ambulatory or preventive care visit during the measurement year
• Commercial members who had an ambulatory or preventive care visit during the measurement year or the two years prior to the measurement year

Without a patient visit, members do not receive counseling on diet, exercise, smoking cessation, seat belt use and behaviors that put them at risk. If the organization's services are not being used, are there barriers to access? Maintaining access to care requires more than making providers and services available—it involves analysis and systematic removal of barriers to care.

Ambulatory care; preventive care; access

Members age 20 years and older as of December 31 of the measurement year (see the related "Denominator Inclusions/Exclusions" field)

Medicaid and Medicare: One or more ambulatory or preventive care visits during the measurement year

Commercial: One or more ambulatory or preventive care visits during the measurement year or the two years prior to the measurement year

See the related "Numerator Inclusions/Exclusions" field.

Unspecified

All HEDIS measures undergo systematic assessment of face validity with review by measurement advisory panels, expert panels, a formal public comment process and approval by the National Committee for Quality Assurance's (NCQA's) Committee on Performance Measurement and Board of Directors. Where applicable, measures also are assessed for construct validity using the Pearson correlation test. All measures undergo formal reliability testing of the performance measure score using beta-binomial statistical analysis.

Age greater than or equal to 20 years

December 31 of the measurement year

Inclusions
Members age 20 years and older as of December 31 of the measurement year

Note:

• Members must have been continuously enrolled during the measurement year for Medicaid and Medicare members, or during the measurement year and two years prior to the measurement year for commercial members.
• Allowable Gap: No more than one gap in enrollment of up to 45 days during each year of continuous enrollment. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage.

Exclusions
Unspecified

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site  to purchase HEDIS Volume 2, which includes the Value Set Directory.

Inclusions
Medicaid and Medicare: One or more ambulatory or preventive care visits during the measurement year

Commercial: One or more ambulatory or preventive care visits during the measurement year or the two years prior to the measurement year

Use the following value sets to identify ambulatory or preventive care visits:

• Ambulatory Visits Value Set
• Other Ambulatory Visits Value Set

Exclusions
Unspecified

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site  to purchase HEDIS Volume 2, which includes the Value Set Directory.

Unspecified

This measure requires that separate rates be reported for commercial, Medicaid, and Medicare product lines.

Report three age stratifications and a total rate:

• 20 to 44 years
• 45 to 64 years
• 65 years and older
• Total

The total is the sum of the age stratifications.

Adults' access to preventive/ambulatory health services (AAP).

Unspecified

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

This measure was not adapted from another source.

Unspecified

Unspecified

This is the current release of the measure.

This measure updates previous versions:

• National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
• National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Source available for purchase from the National Committee for Quality Measurement (NCQA) Web site .

For more information, contact NCQA at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .

The following is available:

• National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical update. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Oct 1. 12 p.

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .

This NQMC summary was completed by ECRI on August 7, 2003. The information was verified by the measure developer on October 24, 2003.

This NQMC summary was updated by ECRI on June 16, 2006. The updated information was not verified by the measure developer.

This NQMC summary was updated by ECRI Institute on May 15, 2008. The information was verified by the measure developer on June 17, 2008.

This NQMC summary was updated by ECRI Institute on March 27, 2009. The information was verified by the measure developer on May 29, 2009.

This NQMC summary was updated by ECRI Institute on February 4, 2010 and on June 7, 2011.

This NQMC summary was retrofitted into the new template on July 1, 2011.

This NQMC summary was updated by ECRI Institute on September 18, 2012, August 2, 2013, February 3, 2014, April 15, 2015, and again on February 19, 2016.

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For detailed specifications regarding the National Committee on Quality Assurance (NCQA) measures, refer to HEDIS Volume 2: Technical Specifications for Health Plans, available from the NCQA Web site at www.ncqa.org .