The National Committee for Quality Assurance (NCQA) released new technical specifications for the Healthcare Effectiveness Data and Information Set (HEDIS), for 2019, including four new measures.
HEDIS is a widely used performance improvement tool. The new HEDIS volume includes four new measures, changes to four existing measures and two cross-cutting topics that address enhancements across multiple measures.
The newest additions to HEDIS address emerging health priorities, such as opioid use disorder, and evolving processes in care delivery, such as telehealth.
One new measures addresses the risk of continued opioid use, specifically the percentage of members 18 years and older who have a new episode of opioid use that puts them at risk for continued use. Two rates are reported: the percentage of members whose new episode of opioid use lasts at least 15 days in a 30-day period, and the percentage of members whose new episode of opioid use lasts at least 31 days in a 62-day period.
Continued opioid use for noncancer pain is associated with increased risk of opioid use disorder, opioid-related overdose, hospitalization and opioid overdose-related mortality, NCQA officials said. “This measure assesses members with a new episode of opioid use who are dispensed opioids for a period of time that puts them at an increased risk of continued use,” the organization said in a press release.
NCQA has added the following two new measures specified for the HEDIS Electronic Clinical Data Systems reporting method. Data sources include administrative claims, electronic medical records, registries, case management systems and health information exchanges.
Another new measure assesses outcomes for Medicare Advantage beneficiaries who require skilled nursing services, specifically assessing the percentage of skilled nursing facility discharges to the community that result in an unplanned hospitalization within 30 days and 60 days.
“This measure assesses the coordination of providers and services to support a successful transition to the community from a skilled level of care across Medicare Advantage plans,” NCQA stated.
A third new measure assesses prenatal immunization status by looking at the percentage of deliveries on or after 37 gestational weeks in which women received influenza and diphtheria and pertussis (Tdap) vaccines. “This measure assesses receipt of important prenatal vaccines, which protect women and their infants from influenza and tetanus, diphtheria and pertussis,” the organization stated.
A fourth new measure focuses on adult immunization status, by assessing the percentage of adults 19 years and older who are up to date on recommended routine vaccines for influenza, tetanus and diphtheria (Td) or tetanus, Tdap, herpes zoster and pneumococcal.
The HEDIS changes also include revisions to four existing measures. One update sets a new blood pressure target of <140/90 mm Hg for all adults age 18–85 with hypertension in accordance with updated clinical recommendations. NCQA also has updated the approach to allow for more administrative methods to collect the measure and added telehealth encounters to satisfy certain components of the measure.
NCQA also revised the measure of follow-up after emergency department visit for mental illness by adding a principal diagnosis of intentional self-harm to the denominator and a principal diagnosis of intentional self-harm with a secondary diagnosis of a mental health disorder to the numerator.
NCQA also revised the plan all-cause readmissions measure. This measure will now include observation stays as index hospitalizations and readmissions events for all product lines. The measure also will remove individuals with high frequency hospitalization from the risk-adjusted readmission rate and report a rate of these outlying individuals among the plan population for all product lines. NCQA added a separate readmissions rate among index hospitalizations discharged to a skilled nursing facility for the Medicare product line.
NCQA is publishing the revised Plan All-Cause Readmissions measure alongside others released for HEDIS 2019, but delaying implementation until HEDIS 2020. NCQA worked with the Centers for Medicare & Medicaid Services (CMS) to identify the timeline, given the extent of the measure changes and use of the measure in the Medicare Advantage Star Ratings System.
NCQA also introduced telehealth into 14 existing physical health measures for HEDIS 2019, following on previous work to add telehealth services to behavioral health measures last year.
Quality measures that were designed and intended for a general adult population may not always be appropriate for those with limited life expectancy or advanced illness and frailty. As such, NCQA is implementing cross-cutting exclusions across selected HEDIS measures to help focus on the population who are most likely to benefit from the measured services.
For HEDIS 2019, the following nine measures exclude individuals 65 and older who have an advanced illness and frailty or who live long-term in nursing home settings. Four of these measures also exclude those age 80 and older with frailty: breast cancer screening, colorectal cancer screening, comprehensive diabetes care, controlling high blood pressure, disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis, osteoporosis management in women who had a fracture, persistence of beta-blocker treatment after a heart attack, statin therapy for patients for cardiovascular disease and statin therapy for patients with diabetes.