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Contact Information:

Mailing Address:
Texas Diabetes Program / Council
MC 1965
Texas Department of State Health Services
PO Box 149347
Austin, Texas
78714-9347

Physical Address:
1100 West 49th Street
Austin, Texas 78756

Phone: (512) 458-7490
Fax: (512) 458-7408

Health Maintenance Organization (HMO) Recognition Program

Insurance In 2005, the Texas Diabetes Council implemented an HMO recognition program to encourage improvement in performance measures for diabetes care in Texas.

Acknowledging the impact HMOs have on quality of care for Texans with diabetes, the Council invites organizations who surpass the state average for all HEDIS® measures relating to comprehensive diabetes care to be honored at a Council meeting, and appear in listings in Texas Diabetes and on the Council web site.

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

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

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

*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 Council’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 six HEDIS® performance measures for comprehensive diabetes care are listed with corresponding state and national averages below:

Percentage of members 18 through 75 years of age with type 1 or type 2 diabetes using the HMO who . . .	Texas Average 2006	National Average 2006*
had one or more HbA1c tests conducted within the past year.	82.5%	87.5%
had their most recent HbA1c level greater than 9.5 percent during the past year.**	57%	29.7%
had an eye screening for diabetic retinal disease within the past year.	35.5%	54.8%
had their most recent LDL-C level less than 130 mg/dL within the past two years.	45.1%	67.5%
had a LDL-C test done within the last two years.	88.6%	92.3%
had screening for nephropathy or evidence of already having nephropathy within the past year.	45.8%	55.1%

*National averages are presented as goals for the state.
**The Texas Diabetes Council recommends A1c <6 %. 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 March 13, 2008