Public Comment Period is Open February 13 – March 13

NCQA’s public comment period is open and ready for your input!

Public comment is an opportunity for health plans, purchasers, consumers and other stakeholders to weigh in on the relevance, scientific soundness and feasibility of new and revised measures for HEDIS.

NCQA seeks comments on the following:

  • New HEDIS measures assessing cardiac rehabilitation utilization, kidney health evaluation for diabetic patients and osteoporosis screening for older women.
  • Revisions to thirteen existing measures.
  • Exclusions for palliative care that apply across multiple measures.
  • Retirement of six measures.
  • Evaluation of the health plan descriptive domain.

About HEDIS and Public Comment

HEDIS® comprises measures of clinical quality and patient experience that are based on published scientific evidence. When new evidence becomes available, NCQA reviews HEDIS measures to determine whether changes may be needed. NCQA convenes multi-stakeholder advisory groups—including independent scientists, clinicians, consumers and purchasers—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

An important part of developing and updating HEDIS is hearing from the public. NCQA reviews every comment received during public comment and presents results to its advisory panels for deliberation.

NCQA’s HEDIS measures do not constitute clinical practice guidelines, nor should they be used to determine insurance or coverage.

Proposed New Measures

Cardiac Rehabilitation: Assesses whether adults participated in cardiac rehabilitation following a heart attack or other event.

Importance: Cardiac rehabilitation, a personalized outpatient program of supervised exercise and education, has been shown to improve the health of patients who had cardiac events and procedures.

Kidney Health Evaluation for Patients With Diabetes: Assesses whether adults with diabetes received an annual kidney health evaluation.

Importance: Diabetes places adults at higher risk for kidney disease. Despite clinical guidelines, few individuals receive appropriate screening and monitoring.

Osteoporosis Screening in Older Women: Assesses the percentage of women 65 and older who were screened for osteoporosis.

Importance: Osteoporosis affects bone density, increasing the risk of fractures. Osteoporotic fractures can lead to complications or death.

Proposed Changes to Existing Measures

Well-Child Measures: NCQA proposes to update this set of measures by adding previously excluded age groups, streamlining the measures and removing the medical record option for Medicaid plans, which will align reporting with that of commercial plans.

Emergency Department Utilization: This risk-adjusted measure assesses the rate of emergency department (ED) visits among adults. NCQA proposes to no longer count ED visits that convert to observation stays as ED utilization. NCQA also proposes tracking high-frequency ED utilizers as a separate reporting rate. These changes will align the measure with approaches in other risk-adjusted utilization HEDIS measures.

Use of High-Risk Medications in Older Adults: This measure assesses whether adults had multiple dispensing events for a high-risk medication, which may signal a safety concern. NCQA proposes to add antipsychotics and benzodiazepines to the list of high-risk medications, revise the measure criteria and make other adjustments to further align the measure with the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

Transitions of Care: This measure assesses whether providers caring for adults recently discharged from the hospital properly communicated with one another. NCQA proposes updates to clarify how to report the measure.

Controlling High Blood Pressure: This measure assesses whether adults with hypertension had their blood pressure controlled. NCQA proposes revisions that would allow more time for interventions to address controlling blood pressure.

Follow-Up After Hospitalization for Mental Illness: This measure assesses whether children and adults who were hospitalized for treatment of mental illness or intentional self-harm had timely follow-up with a mental health provider. NCQA proposes allowing care in behavioral health care settings to count as follow-up, without requiring a provider type. NCQA also proposes to allow Community Mental Health Centers and Certified Community Behavioral Health Clinics to meet the definition of mental health provider.

Adult Immunization Status: This measure assesses whether adults are up-to-date on recommended vaccines. NCQA proposes updating the pneumococcal immunization rate to align with newly updated guidelines of the Advisory Committee on Immunization Practices.

Unhealthy Alcohol Use Screening and Follow-Up: This measure assesses whether adults were screened for unhealthy alcohol use and received timely follow-up care when needed. NCQA proposes revisions to allow screenings that may have led to a diagnosis of alcohol use disorder to count toward the measure.

Depression Screening and Follow-Up Measures: Three measures assess whether adolescents and adults, prenatal women and postpartum women were screened for depression and received timely follow-up care when needed. NCQA proposes to adjust the screening threshold to help focus follow-up care resources on those who are most likely to have depression.

Palliative Care Exclusion: NCQA proposes to exclude members receiving palliative care from 1 proposed measure and 12 existing measures that address inappropriate medication use, screening and disease management. Palliative care focuses on pain and other symptom relief for individuals with serious illnesses. Quality measures designed for the general population may not be appropriate for individuals receiving this care.

Proposed Measure Retirements

Annual Dental Visit: Assesses whether youths visited a dental practitioner.

Rationale: The measure does not address the quality of dental care provided. NCQA is assessing improved measures in dental care.

Adult BMI Assessment: Assesses whether adults had their BMI documented in the last two years.

Rationale: Because the calculation of BMI is now a common standard of practice, this measure potentially sets a low bar to address the important issue of obesity.

Medication Management for People with Asthma: Assesses whether children and adults with persistent asthma use asthma controller medication.

Rationale: New asthma medication recommendations in forthcoming clinical guidelines may affect how measure results are interpreted.

Children and Adolescents’ Access to Primary Care Practitioners: Assesses whether youths had a visit with a primary care practitioner.

Rationale: This measure provides potentially limited actionable information.

Comprehensive Diabetes Care—Medical Attention for Nephropathy: Assesses whether adults with diabetes had medical attention for kidney disease.

Rationale: The nephropathy measure does not align with evidence-based tests recommended for kidney health evaluation.

Comprehensive Diabetes Care—HbA1c Control <7.0%: Assesses whether blood sugar levels were tightly controlled for certain adults with diabetes.

Rationale: Stakeholders have questioned whether this measure continues to provide value, given the difficulties collecting the measure.

Additional Item

Health Plan Descriptive Measures: NCQA is evaluating the health plan descriptive domain with the goal of simplifying reporting and reducing customer burden while ensuring that reported data are meaningful.

How to Participate in Public Comment

For details on the proposed changes and to make your comments, visit http://www.ncqa.org/HomePage/NCQAPublicComments.aspx

The public comment period begins at 9:00 AM (ET) on February 13 and ends at 11:59 PM (ET) on March 13.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).