This report presents results from an analysis of outcomes of care for children enrolled in the Healthy and Well Kids in Iowa program ( hawk-i) . The analyses were conducted by The University of Iowa Public Policy Center for the Iowa Department of Human Services (IDHS). The hawk-i program is that portion of the Iowa State Child Health Insurance Program (SCHIP) that exists separately from Medicaid and provides services to children in families with incomes between 133% and 200% of the Federal Poverty Level (FPL). The IDHS contracts with John Deere Health Plan, Iowa Health Solutions and Wellmark Blue Cross/Blue Shield to provide services to hawk-i enrollees on a county-by-county basis. This report provides a summary of the results for 10 different outcomes of care in four different service areas: preventive visits for children and youth, dental visits, Measles, Mumps and Rubella (MMR) immunizations, and behavioral and emotional health visits. The results are presented separately for each of the three health plans.

This first evaluation of outcome measures is part of the quality assurance activities for the
hawk-i program. The measures were adapted from the Healthplan Employer Data and Information Set (HEDIS). HEDIS is a set of measures developed by the National Committee for Quality Assurance (NCQA) for evaluating the outcomes of health plans. The hawk-i clinical advisory committee, in collaboration with researchers from the University of Iowa Public Policy Center, identified the four service areas. These HEDIS measures were then adapted to fit the available hawk-i data. The HEDIS outcome measures (i.e., utilization rates) were determined through an analysis of claims, encounter, and eligibility data for children in each of the hawk-i health plans. The inter-plan comparisons presented here allow us to determine whether the plans are meeting the expectations for care provision within the hawk-i program.

Outcome data should always be interpreted with caution. Limitations of this data may include differential rates of missing data across the plans, the systematic use of inappropriate codes, or the miscoding of diagnoses. Despite these limitations, important knowledge is gained by comparing outcome results between plans.   

National Committee on Quality Assurance. The Healthplan Employer Data and Information Set (HEDIS). Available at http://www.ncqa.org/Programs/HEDIS/ . Most recently accessed October 3, 2003.