HEDIS Measure Changes and Updates

In a year where we find ourselves using the word “unprecedented” far too often, NCQA’s recently released HEDIS updates continues the trend.  Not only are some of the measure changes unprecedented, but this update contains an unprecedented volume of high-impact measure changes.   

While health plans continue facing unique decisions and challenges due to the ongoing COVID-19 Public Health Emergency, plans and providers must also pay close attention to the following HEDIS measure changes to remain competitive and to earn strong Star Ratings this year.  Here is a brief summary of the most impactful changes announced:

  • The following measures have been retired by NCQA for Medicare:
    • Adult BMI Assessment; effective MY2020
    • Medication Reconciliation Post-Discharge (retired as stand-alone measure; now represents 4th indicator of TRC); effective MY2020
    • Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART); effective MY2021
  • NCQA added required palliative care exclusions to the following measures to best help plans ensure that the right members are receiving the right care based on their health status:
    • Breast Cancer Screening (BCS)
    • Colorectal Cancer Screening (COL)
    • Controlling Blood Pressure (CBP)
    • Comprehensive Diabetes Care (CDC)
    • Statin Therapy for Cardiovascular Disease (SPC)
    • Osteoporosis Management for Women with Fracture (OMW)
  • NCQA announced expanded ability to use telehealth for various Medicare measurement purposes:  
    • Telephone visits, e-visits, & virtual check-ins added:
      • As advanced illness exclusions (BCS, COL, CBP, SPC, CDC, ART, OMW)
      • For use for both visits to identify diabetic members, hypertensive members and members with CVD
      • To identify members with chronic diagnosis (FMC)
      • For use as appropriate settings for BP readings (CBP)
      • To meet the criteria for Care of Older Adults Measures
    • E-visits & virtual check-ins meet numerator criteria for Patient Engagement After Inpatient Discharge
  • Measurement criteria were changed to allow expanded remote BPs, use of AI, and member reported BPs to:
    • Allow BPs taken by any remote digital device (CBP)
    • Remove the exclusion of BP readings reported or taken by member (CBP)
    • Allow Eye Exam results read by artificial intelligence (AI) to meet criteria (CDC-DRE)
  • Other notable changes for individual measures include:
    • Controlling Blood Pressure (CBP) measure revised to look for two outpatient visits with a diagnosis of hypertension in first six months of measurement year and year prior to measurement year.
    • Transitions of Care (TRC) measure changes:
      • Revised timeframe for Notification of Inpatient Admission and Receipt of Discharge Information
      • Revised the “one medical record” requirement to the “outpatient record that is accessible to the PCP or ongoing care provider”
      • Added note that the Medication Reconciliation does not require the member to be present
    • Changes to allow member-reported biometric values (height, weight, BMI percentile) if the information is collected by a primary care practitioner or specialist, if the specialist is providing a primary care service related to the condition being assessed, while taking a patient’s history. The information must be recorded, dated and maintained in the member’s legal health record.
  • New measures which align with previous CMS announcements of new measurement concepts, and which CMS may potentially consider as future Star Ratings measures through rulemaking include:
    • Cardiac Rehab (CRE)
    • Kidney Health Evaluation for Patients with Diabetes (KED)
    • Osteoporosis Screening in Older Women (OSW)
  • Finally, NCQA specifically reminds plans: to exclude deceased members from all measures and indicators.  

The sheer volume and sweeping nature of these significant changes will undoubtedly change the strategies and tactics used by MA plans to engage with members and providers.  For information or assistance with these changes, reach out to us to start the conversation.

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