Kidney Health: A New HEDIS Measure

A  measure that improves kidney health nationwide, especially for those most at risk. That’s the vision for the Kidney Health Evaluation for Patients with Diabetes measure that makes its debut in this year’s HEDIS portfolio of measures.

Kidney disease affects 37 million American adults, but 90% are unaware they even have it. NCQA and The National Kidney Foundation (NKF) hope to change that with a new Kidney Health Evaluation for Patients with Diabetes they developed together. The new HEDIS measure will improve kidney disease testing in people with diabetes which is a key risk factor for developing kidney disease.

Kidney Health: The Measure

Clinical guidelines recommend people with diabetes should be routinely tested to detect kidney disease. While the tests associated with kidney disease detection and diagnosis are inexpensive and widely available for routine clinic visits, fewer than 50% of people with diabetes get both tests. The new Kidney Health Evaluation HEDIS Measure reveals these gaps in care for clinicians, healthcare leadership and health plan executives.

“For almost two years, NKF has been working in partnership with NCQA to advance the development of the Kidney Health Evaluation measure,” said Joseph Vassalotti, MD, Chief Medical Officer, NKF. “The inclusion of the new measure in the HEDIS Measurement Year 2020 & Measurement Year 2021 publication is a giant step towards engaging the nation’s health plans, integrated health networks, and individual primary care practitioners to improve the diagnosis of kidney disease.”

The new measure tracks the percentage of adults with diabetes (age 18-85) who received an annual kidney health evaluation, including both an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR). The NKF-developed Kidney Profile is one way to amplify testing that combines the eGFR, which assesses kidney function, with the uACR, which assesses kidney damage. Results of the Kidney Profile provide health plans, physicians and patients with the critical information they need to identify chronic kidney disease (CKD) and develop a treatment plan which may include additional testing, lifestyle changes, medicine, and a referral to a nephrologist for further evaluation.

“We value this successful collaboration with the National Kidney Foundation, especially the new measure we’ve crafted together. Its inclusion only strengthens the HEDIS mission to improve care for all patients, but especially those who live with diabetes and kidney disease,” said Dr. Mary Barton, Vice President, Performance Measurement, NCQA. “We know measures work, in terms of accountability. They give health plans and providers a focal point for improvement. This measure will ultimately lead to better care and improved kidney health across the country.”

Measure Development

The development of the Kidney Health Evaluation HEDIS measure was the result of a large multidisciplinary, multi-stakeholder technical expert panel (TEP) drawing on expertise from governmental, private practice, and health care organization representatives. The TEP was comprised of kidney patients, clinical experts in kidney disease, diabetes, and public health, primary care professionals, researchers, and medical informaticists who contributed to the measure design. The development of the measure was also supported by several NCQA Measurement Advisory Panels including those focused on diabetes, geriatrics and the technical implications of HEDIS.

“Kidney disease is under-diagnosed in primary care with as many as 90% of people unaware they even have the disease. This includes as many as 50% of people with advanced kidney disease who may ultimately require dialysis or a transplant to survive,” added Dr. Vassalotti.  “Because kidney disease is asymptomatic in its earliest stages, routine testing among those at the highest risk for developing the disease is the only way to diagnose it early and help stave off its life-threatening complications. “

Representatives of several important stakeholder groups participated in the development of this measure including the American Diabetes Association, American Medical Group Association, Centers for Disease Control and Prevention, Indian Health Service and the National Institute of Diabetes and Digestive and Kidney Diseases.

Practices and plans, we want to hear from you. What are you doing to improve your patients’/members’ kidney health? Will this measure improve your performance?  Please, weigh in. The comment section is below.

About HEDIS Measures

The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health care’s most widely used performance improvement tools. Approximately 191 million people are enrolled in plans that report HEDIS results. HEDIS includes more than 90 measures across 6 domains of care: effectiveness of care, access/availability of care, experience of care, utilization and risk-adjusted utilization, health plan descriptive information, measures collected using electronic clinical data systems. For more information visit ncqa.org.

About Kidney Disease

In the United States, 37 million adults are estimated to have chronic kidney disease—and more than 90 percent unaware of it.  1 in 3 American adults are at risk for chronic kidney disease.  Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history. People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease. African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end-stage renal disease (kidney failure).

About the National Kidney Foundation

The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.

One thought on “Kidney Health: A New HEDIS Measure

  1. NCQA has come up with another process measure that fails to correlate with outcomes. Measuring eGFR and uACR have been recommended for years and frequently measured in the primary care setting. The unfortunate fact is that identifying advancing kidney disease in patients with diabetes or hypertension is not associate with reversing or arresting CKD. Effective interventions need to occur further upstream with effective treatment of hypertension and diabetes. The lack of effective treatment is particularly significant in the elderly where there is also the effect of aging on renal function. There are few treatments available the clearly significantly slow down the progress of CDK in patients with diabetes and hypertension. It is difficult to predict which patients will benefit. We must assume that the treatment of diabetes and hypertension would occur with or without these metrics.

    Quality is measured by outcomes or surrogate intermediate measures that are known to improve outcome. NCQA needs to measure the steps taken by the provider and health care system when these measures are abnormal that has been shown to prevent or reverse CKD. Until we focus on outcome measures we only add cost and complexity to the delivery system without benefit to the patient.

    I would note that the neither the ACP nor the AAFP are at the table. NCQA adds burden without benefit to the primary care provider.

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