Policies in Practice: Integrating HEDIS and CAHPS Measures into Clinical Care for Medicaid Beneficiaries

This activity is part of a series


Rakesh Jain, MD, MPH
Clinical Professor, Department of Psychiatry
Texas Tech Health Sciences Center School of Medicine – Permian Basin
Midland, TX
Rakesh Jain, MD, MPH

Rakesh Jain, MD, MPH, is a Clinical Professor in the department of Psychiatry at the Texas Tech Health Sciences Center School of Medicine – Permian Basin in Midland, Texas and in private practice in Austin, Texas. Dr. Jain attended medical school at the University of Calcutta in India. He received his Master of Public Health (MPH) degree from the University of Texas School of Public Health in Houston, where he was awarded a National Institute/Center for Disease Control Competitive Traineeship. His research thesis focused on the impact of substance abuse.

Dr. Jain completed his residency in psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He then completed a postdoctoral fellowship in research psychiatry at the University of Texas Mental Sciences Institute in Houston. He was awarded the National Research Service Award in support of his postdoctoral fellowship.

Dr. Jain has been involved in over 100 research projects studying the effects of medications on short-term and long-term treatment of depression, anxiety, pain/mood overlap disorders, ADHD, and psychosis in adult and child/adolescent populations. He has presented at the World Psychiatric Congress held in Prague, and at Depression and Pain Forum meetings internationally. He is the author of 55 articles published in various journals and magazines, such as the Journal of Psychiatric Research and  Journal of Clinical Psychiatry, among others, and has presented over 25 original research posters at meetings such as the American Psychological Association (APA), the American College of Neuropsychopharmacology (ACNP), the American Academy of Child and Adolescent Psychiatry (AACAP), the U.S. Psychiatric Congress, and more. He has co-authored six books that range from patient education to cutting-edge neurobiologic findings in psychiatry and mental health. He serves on several advisory boards focusing on drug development and disease state education. He was also recently the Chair of the U.S. Psychiatric Congress, and for several years, has served as a member of the Steering Committee for U.S. Psychiatric Annual Congress. He is a recipient of the Public Citizen of the Year award from the National Association of Social Workers, Gulf Coast Chapter, in recognition of his community and peer education, and championing of mental health issues.

Sandeep Palakodeti, MD, MPH
Co-Founder, Chief Product Officer, Mishe.co
Former Chief Population Health Officer
University Hospitals Cleveland
Cleveland, OH
Sandeep Palakodeti, MD, MPH

Dr. Sandeep Palakodeti is a practicing internal medicine physician, experienced healthcare executive, and a passionate innovator looking to bring much needed change across our broken American healthcare system. Sandeep is a native of Ohio, where he earned his MD and MPH with a focus on population health and physician leadership. He trained in internal medicine at Kaiser Permanente in San Francisco, followed by a fellowship in Healthcare Innovation and Entrepreneurship at Harvard Medical School.

Dr. Palakodeti started his career as a hospital-based physician at the storied Mayo Clinic in Rochester, MN, but soon became disillusioned with our current “sick care” system which focuses so much energy at the end-state of disease, when someone is already suffering significant complications from chronic issues. He then spent the next part of his career as a physician and leader in various value-based organizations. He served as Chief Clinical Design Officer at CareMore Health, a premier risk-bearing organization serving a diverse Medicare and Medicaid population. He also served as Chief Population Health Officer at University Hospitals in Cleveland, OH, one of the largest health-systems in the country, where he oversaw the Accountable Care Organization (which served over 600k patients) and the self-insured employee plan which covered over 35k commercial beneficiaries.

As an entrepreneur and advocate of startup disruption in healthcare, Sandeep is drawn to the possibilities of reimagining our system through new company formation and currently serves in two prominent leadership roles: as Co-founder and Chief Product Officer of Mishe.co, the first fully-integrated specialty savings plan, and as Co-founder and Chief Medical Officer of Rebel Health Alliance, a national specialty cloud clinic focused on longevity, wellness, optimization, and metabolic health.

Dr. Palakodeti is a staunch supporter of patients over profits and the need for more courage and creativity in the healthcare space. He currently resides back in Ohio with his wonderful wife, Abigail, and their two children, 3 dogs, 10 chickens, and a cat in an idyllic rural setting.

Statement of Need

The Agency for Healthcare Research and Quality (AHRQ) administers the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program, which creates surveys to evaluate patients’ experiences with ambulatory and facility-level care in commercial and Medicaid plans. The Healthcare Effectiveness Data and Information Set, or HEDIS, is an annual report maintained by the National Committee for Quality Assurance (NCQA) that uses patient surveys as well as data from patient charts to evaluate managed care plans’ performance based on 90 measures across six domains of care. Health plans must participate in both to maintain accreditation, as both provide insight into the quality of care members receive when enrolled.

CAHPS and HEDIS measures are updated annually to ensure that the information collected is relevant and actionable. These changes have a particular impact on patients with chronic illnesses and complicated social determinants of health. This educational presentation, hosted by national experts, will look at the updates to CAHPS and HEDIS, how they impact quality care and experience, and what this means for clinicians.

Learning Objectives

  • Assess the impact of HEDIS and CAHPS measures on quality of care and patient experience
  • Identify measures from HEDIS and CAHPS that improve patient outcomes, especially concerning SDoH and chronic illness

Financial Support

This program is supported by an independent medical education grant from CVS Health.

Target Audience

Physicians, nurse practitioners (NPs), nurses, physician associates (PAs), pharmacists, and pharmacy technicians within the CVS Health System

Credit Information

Jointly Accredited Provider

In support of improving patient care, CME Outfitters, LLC, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Interprofessional (IPCE) 0.75

This activity was planned by and for the healthcare team, and learners will receive 0.75 Interprofessional Continuing Education (IPCE) Credit for learning and change.

Physicians (ACCME) 0.75

CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CME Outfitters, LLC, designates this enduring activity for a maximum of .75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses (ANCC) 0.75

This activity is designated for 0.75 contact hour. Nurse practitioners can apply for AMA PRA Category 1 Credit(s)™ through the American Academy of Nurse Practitioners (AANP). AANP will accept AMA PRA Category 1 Credit(s)™ from Jointly Accredited Organizations. Nurse practitioners can also apply for credit through their state boards.

Note for California Nurses

This continuing nursing education activity was approved by the California Board of Registered Nursing. CME Outfitters, LLC’s provider number is CEP15510.

Pharmacists/Pharmacy Tech (ACPE) 0.75

This application-based activity is approved for 0.75 contact hour (0.075 CEUs) of continuing pharmacy credit.
Activity UANs: Pharmacist JA0007185-0000-23-127-H01-P Technician JA0007185-0000-23-127-H01-T

Physician Assistants (AAPA): 0.75

CME Outfitters, LLC, has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credits. Approval is valid until expiration date listed above. PAs should only claim credit commensurate with the extent of their participation.


Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 medical knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

MIPS Improvement Activity

Completion of this accredited CME activity meets the expectations of an Accredited Safety or Quality Improvement Program (IA_PSPA_28) for the Merit-based Incentive Payment Program (MIPS). Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website.

Royal College MOC

Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

Dietetics (CDR)

Completion of this RD/DTR profession-specific or IPCE activity awards CPEUs (One IPCE credit = One CPEU). If the activity is dietetics-related but not targeted to RDs or DTRs, CPEUs may be claimed which are commensurate with participation in contact hours (One 60 minute hour = 1 CPEU). RDs and DTRs are to select activity type 102 in their Activity Log. Performance indicator selection is at the learner’s discretion.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process.

Dr. Jain reports the following financial relationships:

Advisory Board: Adamas Pharmaceuticals, Inc.; Alkermes; Corium, Inc.; Eisai Inc.; Janssen Pharmaceuticals, Inc.; Lilly; Lundbeck; Merck & Co., Inc.; Neos Therapeutics, Inc.; Neurocrine Biosciences, Inc.; Otsuka America Pharmaceutical, Inc.; Pamlab; Pfizer Inc.; Sage Therapeutics, Inc.; Shire Pharmaceuticals; Sunovion Pharmaceuticals Inc.; Supernus Pharmaceuticals, Inc.; Takeda Pharmaceuticals U.S.A., Inc.; Teva Pharmaceuticals USA, Inc.; and Usona Institute

Consultant: AbbVie Inc. (Allergan); Acadia Pharmaceuticals Inc.; Adamas Pharmaceuticals, Inc.; Alfasigma USA, Inc.; Axsome Therapeutics, Inc.; Biogen; Boehringer Ingleheim; Corium, Inc.; Cingulate; Eisai Inc.; Evidera; Impel Pharmaceuticals Inc.; Janssen Pharmaceuticals, Inc.; Lilly; Lundbeck; Merck & Co., Inc.; Neos Therapeutics, Inc.; Neurocrine Biosciences, Inc.; Osmotica Pharmaceuticals; Otsuka America Pharmaceutical, Inc.; Pamlab; Pfizer Inc.; Sage Therapeutics, Inc; Shire Pharmaceuticals; Sunovion Pharmaceuticals Inc.; Supernus Pharmaceuticals, Inc.; Takeda Pharmaceuticals U.S.A., Inc.; Teva Pharmaceuticals USA, Inc.; and Transcend Therapeutics

Research Support: AbbVie Inc. (Allergan); Lilly; Lundbeck; Otsuka America Pharmaceutical, Inc.; Pfizer Inc.; Shire Pharmaceuticals; and Takeda Pharmaceuticals U.S.A., Inc.

Speakers Bureau: AbbVie Inc. (Allergan); Alkermes; Axsome Therapeutics, Inc.; Corium, Inc.; Eisai Inc.; Indivior; Intra-Cellular Therapies, Inc.; Ironshore Pharmaceuticals Inc.; Janssen Pharmaceuticals, Inc.; Lilly; Lundbeck; Merck & Co., Inc.; Neos Therapeutics, Inc.; Neurocrine Biosciences, Inc.; Otsuka America Pharmaceutical, Inc.; Pamlab; Pfizer Inc.; Shire Pharmaceuticals; Sunovion Pharmaceuticals Inc.; Takeda Pharmaceuticals U.S.A., Inc.; Teva Pharmaceuticals USA, Inc.; and Tris Pharma, Inc.

Dr. Palakodeti reports no financial relationships to disclose.

Disclosures were obtained from the following peer reviewer and CME Outfitters, LLC, staff, with no disclosures to report:

  • Joshua Caballero, PharmD, BCPP, FCCP (peer reviewer)
  • Morgan Stockberger, MD (planning committee)
  • Jessica Whelan, DNP, APRN, FPMHNP-BC, RN-BC (planning committee)
  • Susan H. Yarbrough, CHCP (planning committee)
  • Sandra Caballero, PharmD (planning committee)
  • Sharon Tordoff (planning committee)

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Obtaining Credit

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Policies in Practice: Integrating HEDIS and CAHPS Measures into Clinical Care for Medicaid Beneficiaries
Event Date: 10/31/2023