Clinical Quality Management Reports

Supporting patient care

Clinical Quality Management (CQM) reports help primary care providers track and monitor patient care and manage disease conditions. The CQM reports, available on Tufts Health Plan's secure Provider website, show the most recent date of service for recommended screening tests or prescriptions for each HMO and POS member on a primary care provider’s panel:

  • Adolescent Well Care Visits: Annual well-care visit with a PCP or OB/GYN for members age 12–21
  • Asthma Medication Management: Members age 5-85 with persistent asthma who received an asthma controller medication
  • Breast Cancer Screening: Mammogram every two years for female members age 50-74
  • Cervical Cancer Screening: Pap test at least every three years for women age 21–64 or Pap/HPV co-test every five years for women age 30-64
  • Chlamydia Screening: Annual chlamydia screening for women age 16–24 identified as sexually active
  • Colorectal Cancer Screening: One or more of the following for members age 50-75: annual fecal occult blood test, FIT-DNA test every three years, flexible sigmoidoscopy or CT Colonography every five years, or colonoscopy every 10 years
  • Comprehensive Diabetes Care: HbA1c testing every six months, and annual dilated or retinal eye exam, LDL-C test and screening for nephropathy for members age 18-75 identified as having Type 1 or Type 2 diabetes
  • Well Child Visits Ages 3–6: Annual well-care visits with a PCP for children age 3–6
  • Statin Therapy for Patients with Cardiovascular Disease: Male members age 21-75 and female members age 40-75 with clinical atherosclerotic cardiovascular disease who received a high or moderate intensity statin medication
  • Statin Therapy for Patients with Diabetes: Members age 40-75 with diabetes who received a statin medication

Reports are color-coded to show at a glance whether a screening is on schedule, coming due or overdue, or if there is no record of a past screening.

Based on claims data and published monthly, CQM reports are benchmarked against HEDIS performance standards. The online reports can be saved, printed or exported.

To access CQM reports on the secure Provider website

  • Click “Provider/Provider Unit Reports.”
  • Then click “Clinical Quality Management” and select the appropriate year, then the month you would like to view. (The most recent month is listed first.)
  • In the Member Health Management screen, click a topic to open that report.

The Search/Query function can be used to locate a specific member within each report.

If you do not already have access to CQM reports, contact your Access Administrator.