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QEHO Initiatives

The Quality, Evaluation and Health Outcomes Unit (QEHO) has:

  • identified opportunities for strategic improvement in Medicaid program operations.
  • monitored the performance and effectiveness of Medicaid programs and
  • analyzed information to identify patterns of utilization, trends in performance, and opportunities for improvement in delivering care to the populations served by Medicaid in North Carolina.

Please see the Disclaimers below related to Medicaid data.

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County Specific Snapshots for N.C. Medicaid Services

DMA HEDIS Data (Healthcare Effectiveness Data and Information Set)


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Children with Special Health Care Needs (CSHCN) - The Use of Preventive Services by CSHCNs, August 2005



QEHO Disclaimers

Claim History Availability

Since February 2007, the Division of Medical Assistance has only the most recent 72 months (6 years) of claim history data available.  As a result, any measures which require claims history for identifying past services are limited to this time frame.  For some data sets (such as the HEDIS measures), this data limitation could potentially prevent identification for exclusion from the eligible population.  For example, the Cervical Cancer Screening measure relies on claims history to exclude recipients who have had a hysterectomy.  By looking back only six years, a recipient may be incorrectly included in the population if the procedure was performed prior to this time.


Through calendar year 2005, North Carolina included recipients dually enrolled in Medicaid and Medicare in its reporting of Medicaid HEDIS results.   Many states and Medicaid Managed Care Organizations exclude dual-eligibles from HEDIS reporting and as a result, North Carolina reported rates may not be directly comparable to those of other states.  This is particularly true for measures which include enrollees over age 65.  Division of Medical Assistance claims may be incomplete for dual-eligible enrollees if billing entities, such as independent laboratories, submit claims only to Medicare.  For measures which incorporate laboratory testing (such as A1C and lipid testing rates among diabetics), the reported testing rates may underestimate actual rates.

Race and Ethnicity

Effective August 9, 2004, North Carolina implemented an ethnicity code in addition to the race code for the Medicaid population.  As part of the conversion, some individuals were assigned an ethnicity code based on their race and Supplemental Security Income (SSI) status.  For individuals with insufficient information to define an ethnicity code an "Unreported" ethnicity code was applied, which has resulted in some over reporting of this "Unreported" ethnicity code.  As recipients re-enroll into the Medicaid program and this information is updated the ethnicity code may become more reliable over time.

NCHC CHIP Population

The NC Health Choice (NCHC) Children’s Health Insurance Program (CHIP) member population is not included in the NC Medicaid HEDIS reporting, and any required HEDIS measures are reported separately for CHIP members.

HEDIS Compliance Audit

The NC Division of Medicaid’s system for collecting and processing data to produce their annual HEDIS measure reports is not assessed by a HEDIS Compliance Audit evaluation.


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Updated: January 24, 2013