HEDIS®: Update to Shared Risk Adjustment Table

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We found an error in the Shared Risk Adjustment table for HEDIS® 2018, HEDIS® for QRS, and VBP4P MY2017. We mistakenly updated the HCC-Rank and HCC-Comb tabs to include more comorbidities in the risk adjustment models than in previous years, which could lead to an increase in the expected rate of readmission.

Measures this error affects are Plan All-Cause Readmissions (PCR), Acute Hospital Utilization (AHU), Emergency Department Utilization (EDU) and Hospitalization for Potentially Preventable Complications (HPC).

To resolve the issue, NCQA has reposted the Shared Risk Adjustment table. NCQA-certified vendors will retest logic for all four measures to ensure that correct tables are used. Vendors should finish testing by Friday, April 6. All customers that don’t use an NCQA-certified vendor should replace the current file with the updated file NCQA posted on Wednesday, March 28.

Because we understand this correction has implications for many HEDIS users, we are informing as many users as possible via email, our web site and this blog post.

We apologize for the inconvenience. Please submit any questions regarding this matter through My NCQA.

Matt Brock
Matt Brock is the Director of Communications at NCQA. After more than two decades working in broadcast journalism, Matt now leads NCQA’s efforts to develop unique content that engages and informs consumers as well as providers, plans and policymakers via this blog, our website, NCQA.org and numerous social media platforms. Matt’s goal is to educate consumers and to direct them to the best resources when considering quality in their health care decisions.

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