This summer, NCQA piloted a streamlined process to allow for quicker retirement of HEDIS measures. We looked across HEDIS to identify appropriate measures for retirement based on potential limited value-add, diminished relevance and other concerns, and we identified three measures to evaluate. Our vetting process included an examination of performance, a review of technical assistance questions, discussions with key stakeholders and a public comment period.
As a result of this process, NCQA will announce the following changes in the HEDIS 2018 Technical Specifications Update on October 2:
Frequency of Ongoing Prenatal Care: Retire this measure.Prenatal care is critically important. However, stakeholders emphasized that measuring the number of visits alone will not achieve our goal of improving maternal care. HEDIS will continue to include the Prenatal and Postpartum Care measure, which assesses both receipt and timeliness of visits. In addition, we are exploring better measures in maternal care, such as prenatal immunizations and other ways to assess the content of care received during these important visits.
Annual Monitoring for Patients on Persistent Medications: Remove Medicare as a reporting product line; retire the digoxin indicator rate for the commercial and Medicaid product lines.
Given the relatively high performance and low variation among Medicare Advantage plans, stakeholders agreed this measure may be topped out for these plans—but there is room for improvement for Medicaid and commercial plans.
In addition, our geriatric experts raised concerns about the continued relevance of the indicator assessing digoxin monitoring. Experts noted the drug is rarely used; in addition, evidence no longer supports annual serum digoxin level monitoring. Because digoxin is a high-risk drug for elderly patients at certain doses, we continue to monitor this type of usage in the Use of High-Risk Medications in the Elderly HEDIS measure
Children and Adolescents’ Access to Primary Care Practitioners: Measure remains in HEDIS.
Stakeholders did not support retiring this measure, noting its value in monitoring access to primary care during a time of instability and its continued use in various programs. Stakeholders stressed the importance of remaining aligned across programs.
The retirement pilot taught us that NCQA can use a streamlined approach to assess the continued relevance of measures—and confirmed that HEDIS measures are widely used and serve various purposes. A measure may have outlived its purpose for one program but continue to have value for others. Although separating a measure from its many legitimate uses can be difficult, alignment across programs remains a critical goal for NCQA. We will take the lessons learned from this pilot to incorporate a means of continuous evaluation of the HEDIS measure set.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Sepheen Byron is Assistant Vice President of Performance Measurement at the National Committee for Quality Assurance (NCQA). Sepheen has over 15 years of experience in the evaluation of health care quality. At NCQA, Sepheen provides strategic direction on measures development and use, including measures for HEDIS® and other national evaluation programs.