HEDIS, STARs, and IHA AMP all follow National Committee for Quality Assurance (NCQA) guidelines. The difference between the three are the lines of business (LOB) associated to them. The measures also vary by LOB. Organizations such California Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and Integrated Healthcare association (IHA) Align Measures Perform (AMP) determine the metrics.
For example:
• HEDIS – Is categorized as Medi-Cal LOB following California Department of Health Care Services (DHCS) using the Medi-Cal Accountability Set (MCAS) for our measure sets selection.
• STARs- Is categorized as Senior LOB following Centers for Medicare & Medicaid Services (CMS) and using the Measures selection from CMS.
• IHA/AMP- Is primarily categorized as Commercial LOB. However, a handful for Senior and Medi-Cal Health Plans Participate in the program. Commercial and Medi-Cal LOB have incentive programs. Senior only participates in award recognition and is reported on the Office of the Patient Advocate (OPA) website http://www.opa.ca.gov/
o The following plans are participating in the AMP Commercial HMO program
• Aetna • LA Care Health Plan
• Anthem Blue Cross • Molina Healthcare
• Blue Shield of California • Sharp Health Plan
• Cigna Health Care of California • Sutter Health Plus
• Health Net • United HealthCare
• Kaiser Permanente • Western Health Advantage
o The following plans are participating in the AMP Medicare Advantage program
• Blue Shield of California • Sharp Health Plan
• Health Net • United Health Care
• Kaiser Permanente • Western Health Advantage
o The following plans are participating in the AMP Medi-Cal Managed Care program
• Blue Shield of California • Inland Empire Health Plan
• Promise Health Plan
The importance of tracking all three LOB is that each program has its preferred measures selection, guidelines, and incentive programs to achieve their percentile goals and Stars rating.
For further information see the links below:
• DHCS - https://www.dhcs.ca.gov/
• CMS - https://www.cms.gov/
• IHA – AMP https://www.iha.org/
