HEDIS® Measurement Year 2020

The National Committee for Quality Assurance (NCQA) HEDIS® set of quality measures is considered by many to be the gold standard when it comes to quality measurement. NCQA continues to pursue a strategy to find a core set of meaningful measures that will allow for the harmonization of performance measurement across the healthcare industry. As such, NCQA will retire a number of measures, streamline and modify existing measures, and add a small number of meaningful measures for HEDIS Measurement Year 2020 (HEDIS MY 2020). This is the first in a four-part blog series in which we’ll be discussing these changes and sharing tips on understanding and incorporating them into your HEDIS strategy.

Quality measurement trends introduced over the last few years will continue to drive this pursuit.

• Increased use of supplemental data and electronic clinical data to move the field towards more meaningful measurement.
  • Expanding access to, and use of, information-rich, patient-focused clinical data in addition to claims data.
  • Reducing burdensome manual data collection.
• .Continued focus on today’s health priorities
  • Assessing the risk for, and monitoring and treatment of, substance abuse and mental health conditions.
  • Measuring and evaluating facility-based utilization.
  • Aligning measures with current health practices.

For more specific MY 2020 changes, we’ll focus on five key areas:

1. Finding a core set of meaningful measures.

In order to ensure the constant evolution of the HEDIS measurement set, NCQA undertakes a rigorous, consensus-driven review and development of published guidelines and scientific evidence, soliciting feedback from multi-stakeholder advisory panels.

As part of this thoughtful review, NCQA considered a number of factors when determining whether to retire or streamline measures for HEDIS MY 2020:

• The focus on quality of care rather than access to care.
• The consolidation of measures that assess similar conditions or quality outcomes.
• The acknowledgment of changes in industry treatment guidelines and recommendations.
• The achievement of consistently high-performance standards.

A prime example that embodies many of these concepts is the retirement of the Adult BMI Assessment (ABA) measure. Performance on ABA has been trending upward over the past three years across all product lines. Further, this measure has become less relevant as the automatic calculation of BMI in Electronic Health Records (ERH) is now a common standard of practice and occurs at most outpatient visits. Additionally, a recent change to ICD-10 coding guidelines (effective October 2018) allows clinicians to use BMI codes only if BMI falls outside the normal range; for example, if the patient has a clinically relevant condition such as overweight or obesity. Finally, the Centers for Medicare & Medicaid Services is removing this measure from the Star Ratings program beginning with the 2020 measurement year and 2022 Star Ratings.

Another example is the reduction from four well-child measures to two streamlined measures that better align with the American Academy of Pediatrics Bright Futures guidelines for Health Supervision of Infants, Children and Adolescents.

2. Reducing burdensome manual data collection.

NCQA is taking a dual strategy approach to reduce the burden of manual data collection for health plans.

• The ultimate goal is that the expanded use of supplemental data and Electronic Clinical Data Systems (ECDS) will provide insight into patient care and outcomes that is not available through traditional administrative data sources. This will enhance quality reporting capabilities and provide more valuable information to patients, clinicians and payers, while reducing the need for medical record review.
• NCQA will be further reducing medical record abstraction requirements in MY 2020 through the retirement of the Adult BMI Assessment (ABA) measure, the removal of numerators from the Comprehensive Diabetes Care (CDC) measure and removing the hybrid reporting method for the newly consolidated well-child measures. With regards to the latter, an examination of performance for the existing well-child measures showed that, over time, medical record review has had less of an impact on rates. Given the minimal impact on performance and the reported difficulty in identifying well visits during medical record review, experts supported removing the hybrid option from these measures.

3.  Refining mental health assessment and treatment. 

Depressive disorders are common mental disorders that occur in people of all ages. Depressive disorders can complicate and exacerbate other chronic medical conditions, lead to impairment and disability, and result in increased morbidity and mortality. Depression has a large effect on both health care costs and lost productivity. And while numerous studies have demonstrated the effectiveness of screening and treatment for depression, the number of people with untreated or undertreated depression remains high. The use of standardized depression screening tools is essential for tracking depressive symptoms and monitoring patient response to treatment.

Since the depression screening and follow-up measures were first introduced to HEDIS, NCQA has received feedback from stakeholders that a higher threshold to identify members who screen positive will help target available resources to those with a clearer need for follow-up care. As such, the positive finding threshold for depression screening tools has been revised for the Depression Screening and Follow-Up for Adolescents and Adults (DSF), Prenatal Depression Screening and Follow-Up (PND), and Postpartum Depression Screening and Follow-Up (PDS) measures.

4.  Focusing on facility-based utilization.

NCQA continues to refine the risk-adjusted utilization measure output. In HEDIS 2019, we saw modifications to outlier definitions, planned stay criteria, exclusion logic and risk-adjustment calculations for a number of these measures. HEDIS 2020 introduced significant changes to the Plan All-Cause Readmissions (PCR) measure to better align with some of these concepts. This trend continues with MY2020 specifications.

The Emergency Department Utilization (EDU) measure assesses the rate of ED visits among Medicare and commercial members 18 years of age and older. Health plans report the observed and expected rates of ED visits for the eligible population. MY 2020 specifications will include the following modifications to the EDU measure. 

• ED visits that convert to observation stays will be removed from the measure. Observation stays are already included as events in NCQA’s risk-adjusted hospitalization measures, so their removal from the EDU measure prevents double counting of these events.
• High-frequency ED utilizers will now be classified as outliers and will be removed from the risk-adjusted ED rate. Adding outlier logic provides consistency with other risk-adjusted utilization measures and ensures that high-frequency utilization does not skew results.

5.  Aligning Measures with Current Health Practices.

Advances in technology are transforming the way that healthcare is delivered, from virtual visits to remote monitoring devices capable of collecting and transmitting key member data. In the midst of the global pandemic, the availability of these resources is paramount in maintaining continuity of care.

NCQA acknowledged the emergence of these new ways to deliver care by first incorporating telehealth visits into the measure specifications. Beginning with MY2020, they are expanding this to include telephone visits, e-visits and virtual check-ins. For example, measures like Controlling High Blood Pressure (CBP) and Comprehensive Diabetes Care (CDC) no longer have restrictions when assessing event/diagnosis criteria based on virtual encounters; these modifications acknowledge the increased use and importance of these visit types to deliver care.

In addition, member-reported data and biometric values will be considered for the first time if the data is collected by a primary care practitioner (PCP) and incorporated into the member’s legal health record. It seems like there is an application ‘app’ for everything, including recording individual blood pressure and body mass index. Controlling High Blood Pressure (CBP) and Weight Assessment and Counseling for Nutrition and Physical Activity for Children / Adolescents (WCC) allows the use of these remote collected data points to demonstrate compliance with measure specifications. Allowing this data concedes the growing dependence on digital health data in current health practices.

In summary

Overall, we’re seeing continued improvement to align measures with current health practices, enhance care quality and ease reporting restrictions where possible. It’s encouraging that NCQA continues to enlist the opinion of stakeholders who have direct contact with patients, as well as examining measures that can be combined or streamlined. 

Your HEDIS vendor is a key partner for a successful strategy. If you’re in the market, contact us for a demo of our NCQA-certified HEDIS solution, SS&C® CareAnalyzer.