Medicaid Managed Care OB HEDIS Project

This OB/GYN project focuses on ensuring that pregnant members enrolled with in a Medicaid managed care plan receive appropriate prenatal and postpartum care based on national standards of quality utilizing the Healthcare Effectiveness Data and Information Set (HEDIS®). This is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

The selected HEDIS® performance measures are:

1. Initiation of Prenatal Care
2. Frequency of Ongoing Prenatal Care
3. Postpartum Care

In addition to these three HEDIS® measures, physicians will also be submitting a Perinatal Risk Assessment Form to the health plan. Participating OB/GYN physician practices will receive an aggregate financial reward if the physicians as a group meet or exceed the project’s goals.