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    Texas Diabetes Program - Council
    MC 1965
    PO Box 149347 Austin, Texas 78714-9347
    1100 West 49th Street
    Austin, TX 78756

    Phone: (512) 776-7490
    Fax: (512) 776-7408


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Health Maintenance Organization (HMO) Recognition Program

InsuranceTo acknowledge the impact HMOs have on quality of care for Texans with diabetes, the Texas Diabetes Council (TDC) invites organizations who surpass the state average for all HEDIS® measures relating to comprehensive diabetes care to be honored at a quarterly TDC meeting and recognized in Texas Diabetes, the newsletter of the Texas Diabetes Council.

The TDC implemented the HMO recognition program in 2005 to encourage improvement in performance measures for diabetes care in Texas. The awards program was put on hiatus and resumed in 2015 with revised performance measures. 

Organizations are recognized for exceeding the state average in measures related to the ABCs of diabetes (A1c, blood pressure control, cholesterol). In 2015, revised performance measures were established to standardize recognition criteria across HMO types in two categories: non-commercial and commercial. Non-commercial is defined as an organization serving greater than 50 percent Medicare and/or Medicaid patients. Commercial is defined as an organization serving populations with greater than 50 percent utilization of group health insurance.

The two award categories — commercial and non-commercial — are based on the percentage of the plan’s members enrolled in the HMO by product line. The commercial category does not include Medicaid or Medicare members; however, the non-commercial category could include commercial, Medicaid, and Medicare members.

The TDC has recognized the following Texas HMOs for above average, comprehensive diabetes care based on performance charts presented in the Guide to Texas HMO Quality:

 

2016 TDC recognition for exceeding state averages based on 2014* HEDIS® data:

  • Community First Health Plans (San Antonio market) commercial category
    • Exceeded the national average in the blood pressure control measure
  • FirstCare (Abilene and Waco markets) non-commercial category
  • Humana Health Plans of Texas (Corpus Christi, Houston, and San Antonio markets) non-commercial category
    • Exceeded the national average in the LDL-C screening measure in the Corpus Christi and San Antonio markets
  • Scott and White Health Plan (Central Texas market) commercial category
    • Exceeded the national average in six HEDIS measures for diabetes care


2014 TDC recognition for exceeding state averages based on 2013 HEDIS® data:

  • FirstCare (Amarillo market) non-commercial category
  • Humana Health Plans of Texas (Austin and San Antonio markets) non-commercial category
  • Community First Health Plans (San Antonio market) commercial category
    • Exceeded the national average in the blood pressure control measure
  • Scott and White Health Plan (Central Texas market) commercial category
    • Exceeded the national average in six HEDIS measures for diabetes care


2008
2008
  • Humana Health Plan of Texas (San Antonio/Corpus Christi and Austin markets)
  • Scott & White Health Plan
  • UnitedHealthcare/PacifiCare (San Antonio/Houston and Dallas/Austin markets)
  • Valley Baptist Health Plan

 

2007
2007
  • Community First Health Plans
  • HMO Blue Texas
  • Humana Health Plans of Texas (Austin & San Antonio markets)
  • PacifiCare of Texas (San Antonio/Houston & Dallas/Austin markets)
  • Scott and White Health Plan
  • UNICARE Health Plans
  • Valley Baptist Health Plan

 

2006
2006
  • FIRSTCARE (Lubbock market)
  • HMO Blue Texas
  • Humana Health Plans of Texas (Austin & San Antonio markets)
  • PacifiCare of Texas (San Antonio/Houston & Dallas/Austin markets)
  • Scott and White Health Plan
  • Valley Baptist Health Plan

 

2004
2004
  • Great-West Healthcare (Dallas)
  • HMO Blue Texas (Austin and Houston markets)
  • Humana Health Plan of San Antonio (San Antonio market)
  • PacifiCare of Texas (San Antonio)
  • Scott and White Health Plan
  • Valley Baptist Health Plan

*Reports for each year reflect the experience of Texans in HMOs for the previous year.

An above average ranking on all six performance measures relating to diabetes care suggests adherence to standards of care for type 1 and type 2 diabetes, a priority area of the TDC's strategic plan.

The Health Plan Employer Data and Information Set (HEDIS®) consists of standardized performance measures designed for comparing the quality of care of managed care organizations. This tool is used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Basic service HMOs in Texas with 5,000 or more members are required under Texas law to report HEDIS® measures annually to the Center for Health Statistics, Texas Department of State Health Services.

The HEDIS® performance measures for comprehensive diabetes care are listed with corresponding state and national averages below:

Percentage of members 18-75 years of age with type 1 or type 2 diabetes who: 
Texas Average 2014*
National Average 2014
Had one or more HbA1c tests conducted within the past year
87.0%
89.9%
Had their most recent HbA1c level greater than 9.0 percent during the past year**
49.2%
30.5%
Had their most recent HbA1c level less than 8.0 percent during the past year
42.0%
58.9%
Had their most recent HbA1c level less than 7.0 percent during the past year
29.7%
39.8%
Had an LDL-C test done within the last two years

83.9%

84.9%

Had an LDL-C test performed during the previous year with a level reading of less than 100 mg/dL

33.6%

46.7%

Had their most recent blood pressure reading at less than 140 mm Hg systolic and 80 mm Hg diastolic during the past year
21.9%
43.0%

*National averages are presented as goals for the state.
**See Texas Diabetes Council A1c goals at http://www.tdctoolkit.org/algorithms_and_guidelines.asp. While higher percentages for other diabetes performance measures indicate improved performance, a lower percentage for this measure is favorable.

The Guide to Texas HMO Quality is published each year by the Texas Office of Public Insurance Counsel to aid health plan purchasers and consumers choose plans that best meet their needs.

Last updated August 11, 2016