• This is a Healthcare Effectiveness & Data Information Set (HEDIS®) administrative measure and only includes Medicaid Primary beneficiaries.  This differs from the break out grid below that includes dually enrolled beneficiaries.
• The annual reported rate captures activity during the stated measurement year (MY).
• The target trendline in the graph above represents the 25th national benchmark percentile for Medicaid programs across the country.
• Please note that we are unable to obtain the 2019 50th percentile national benchmark due to NCQA requirements.  We re-used the 2018 benchmark for 2019.
• This rate is reported as the number of visits per 1000 member months.

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

This is a measure of ambulatory care emergency department (ED) visits. Ambulatory care is medical care provided on an out-patient basis, meaning there isn't the need for a prolonged stay, or admission, to the medical facility. For this measure, we count each visit to an ED that does not result in an inpatient encounter once, regardless of the intensity or duration of the visit. We count multiple visits to the ED on the same date of service as one visit. This measure does not include mental health or chemical dependency services.

A lower rate is generally better for this measure as an indication that the EDs are being used appropriately for emergency care. The change in our rate in MY 2020 is likely attributable to the COVID-19 pandemic.

This measure can be broken down by many different age groups, but the rate reported here is the rate for all age groups combined.

The MCE Quality Committee decided that in order to better demonstrate the breadth of Medicaid services covered under the Global Committment waiver, DVHA would break out  performance measure data into smaller sub-populations when possible.  In 2017, the calendar year 2016 AMB-ED performance measure was the first to be broken out. 

• Rates in the chart below are based on the Vermont Medicaid Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid and dual Medicaid and Medicare enrollees.  Dually enrolled members are included in these rates because the sub-population break outs include high proportions of members who qualify for both Medicaid and Medicare.
• Populations identified by enrollment or services in state specific special programs:
  • Developmental Disabilities Services (DDS), one or more service with a DDS state service code 2703.
  • Children with Severe Emotional Disturbance (Child SED), represented by recipients with one or more non-crisis service by a Children's Mental Health services provider including: 1009765, 1009781, 1009758, 1009760, 1009784, 1009767, 1009768, 1009763, 1009814, 1009756, 1004136, 1007095, 1009764, 1009782, 1009759, 1009761, 1009783, 1009766, 009769, 1009762, 1009815, 1009757, 1009831.
  • Choices for Care (CFC), represented by eligibility for recipient placements between '010' and '030'.
  • Traumatic Brain Injury Program (TBI), one or more services with a TBI state service code 2713.
  • Community Rehabilitation and Treatment Programs for adults with severe and persistent mental illness, one or more services with a CRT state service code 916.

Last updated:  January 2024

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