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NCQA publishes proposed changes to HEDIS measures for MY 2023

The Nationwide Committee for High quality Assurance (NCQA) has launched proposed updates and modifications to HEDIS® measures for Measurement Yr 2023 (MY 2023) for public suggestions, with the general public remark interval ending Friday, March 11. Right here, we check out the brand new additions, modifications, retirements, and dialogue factors for MY 2023 to assist well being plans digest these proposed updates throughout NCQA’s public remark interval.

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Proposed new HEDIS measures

Dental measures

As NCQA retires the Annual Dental Go to (ADV) measure, it’s proposing so as to add two new HEDIS measures associated to dental care: Oral Analysis, Dental Companies; and Topical Fluoride for Youngsters. The group notes that cavities are some of the widespread continual circumstances in kids within the U.S., and common evaluations and topical fluoride functions are a preventative remedy for tooth decay. Each measures are tailored from present Dental High quality Alliance (DQA) measures.

Measure Title

Abstract of Proposed Particulars

Oral Analysis, Dental Companies (OED)

 

The proportion of members below 21 years of age who obtained a complete or periodic oral analysis with a dental supplier throughout the MY.

 

Topical Fluoride for Youngsters (TFC)

The proportion of members 1–20 years previous who obtained a minimum of two topical fluoride functions throughout the MY.

 

Social Want Screening and Intervention

As NCQA will increase its concentrate on social determinants of well being (SDoH), one other new proposed HEDIS measure (SNS-E) would display screen members for unmet meals, housing, and transportation wants and decide whether or not an intervention was carried out for recognized wants. Screenings would come with:

  • Meals screening: The proportion of members who have been screened for unmet meals wants.
  • Meals intervention: The proportion of members who obtained a corresponding intervention inside 1 month of screening optimistic for unmet meals wants.
  • Housing screening: The proportion of members who have been screened for unmet housing wants.
  • Housing intervention: The proportion of members who obtained a corresponding intervention inside 1 month of screening optimistic for unmet housing wants.
  • Transportation screening: The proportion of members who have been screened for unmet transportation wants.
  • Transportation intervention: The proportion of members who obtained a corresponding intervention inside 1 month of screening optimistic for unmet transportation wants.

This measure is a component of a bigger try by NCQA to enhance well being fairness and enhance accountability amongst well being plans to guage and deal with social determinants of well being for members. As NCQA notes, these wants have been recognized as a precedence by well being plans, suppliers, and different well being system entities, requiring a concentrate on measuring components that transcend typical scientific operations and outcomes. As there isn’t any present nationwide well being plan measure to find out and deal with members’ social wants, NCQA states, the group is prioritizing this measure to fill the present hole.

Notably, the brand new proposed Social Wants measure can be reported utilizing the utilizing the HEDIS Digital Medical Knowledge Methods (ECDS) reporting customary.

Emergency Division Visits for Hypoglycemia in Older Adults With Diabetes

NCQA is proposing a measure that might deal with emergency division visits for hypoglycemia in diabetes sufferers 65 years and older.

Measure Title

Abstract of Proposed Particulars

Emergency Division Visits for Hypoglycemia in Older Adults With Diabetes (EDH)

For members 65 years and older with diabetes (varieties 1 and a pair of), the risk-adjusted ratio of observed-to-expected emergency division (ED) visits for hypoglycemia throughout the MY.

As grownup diabetics age, they turn into extra susceptible to the unfavorable results of therapies meant to decrease glucose, NCQA notes. They’re additionally likelier to expertise extreme hypoglycemia, or low blood sugar, which results in fall-related occasions and an elevated danger of each cardiovascular occasions and cognitive decline. With the elevated probability of those doubtlessly damaging penalties, stopping hypoglycemia turns into key to aiding affected person security and avoiding intensive glycemic management. This is a chance for well being plans to tell apart older diabetic sufferers with a excessive danger of hypoglycemia and implement becoming alternatives for prevention.

Proposed modifications to present measures

Grownup Immunization Standing

NCQA is updating the present HEDIS measure for Grownup Immunization Standing (AIS-E). The AIS-E measure evaluates the proportion of adults who’re present on customary vaccinations, with separate indicators for influenza; tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap); zoster; and pneumococcal vaccinations. The proposed replace will assess pneumococcal vaccination standing whereas making new allowances and distinctions for member age-related components and underlying circumstances.

Measure Title

Abstract of Proposed Adjustments

Grownup Immunization Standing (AIS-E)

Pneumococcal numerator:

  • Measure vaccinations amongst adults aged 65 and older, no matter any underlying circumstances. This measure doesn’t embrace adults below the age of 65 because of the feasibility of figuring out underlying circumstances.
  • Revising the numerator time-frame to incorporate the receipt of vaccines between the age of 18 years and the top of the measurement interval, since members with particular circumstances might be vaccinated at youthful ages.
  • Embrace the receipt of PCV20, PCV15, PCV13 or PPSV23 for the numerator, as some adults aren’t really helpful to be re-vaccinated with new vaccines.

All numerators:

  • Standardize age ranges throughout product traces for all numerators.

Deprescribing of Benzodiazepines in Older Adults

This measure was initially included in MY 2022 specs however was delayed to as a substitute be launched in MY 2023 because of the proposed modifications. NCQA initially proposed an intermediate taper of ≥20% for members discontinuing the utilization of benzodiazepines, as a consequence of issues concerning the results of withdrawal. However NCQA has performed testing that implies sure members can attain 100% discontinuation with out an intermediate taper and with out opposed results.

Measure Title

Abstract of Proposed Adjustments

Deprescribing of

Benzodiazepines in Older Adults (DBO)

  • Embrace a direct reference code for palliative care.
  • Embrace the Guidelines for Allowable Changes of HEDIS part.
  • Embrace language to clarify numerator compliance for members reaching 100% discontinuation.
  • Embrace step to “Calculating variety of days lined” definition for prescriptions allotted on totally different days with out overlapping days provide.
  • Embrace word that the identical assumptions from “Calculating variety of days lined” definition apply to “DME each day dose” and “common beginning DME” calculations.
  • Embrace directions for rounding to “Ending DME” and “PDC” definitions.

Proposed measure retirements

Frequency of Chosen Procedures

NCQA is trying to retire the Frequency of Chosen Procedures (FSP) HEDIS measure, which recaps the utilization of often carried out procedures with excessive variation and highlighted potential for being over- and underutilized throughout scientific procedures. This measure was initially proposed in a previous public remark to be retired for MY 2022, however the retirement determination has been pushed to MY 2023. FSP consists of procedures resembling:

  • Tonsillectomy
  • Bariatric weight reduction surgical procedure
  • Hysterectomy
  • Cholecystectomy
  • Again surgical procedure

NCQA’s causes for retiring this measure embrace:

  • Low utility and actionability. With out adjusted efficiency scores, decoding measure outcomes is difficult and never acceptable for plan comparisons. And the dearth of efficiency benchmarks makes it troublesome for well being plans to focus on efficiency enchancment.
  • Its size and complexity creates a major burden on sources for well being plans, distributors, and auditors, as a consequence of an extra of information variables and stratification mixtures.
  • Unreliable validity as a consequence of interpretation variance through the years, as many stratifications create small pattern sizes for particular person reporting classes. 

Choose CAHPS® well being plan measures (FVA, FVO, PNU)

NCQA is trying to make modifications to AIS-E, together with retiring three immunization measures reported with the CAHPS® Well being Plan Survey methodology. Since AIS-E will likely be publicly reported in MY 2022, these proposed measure retirements are being recommended as a part of an effort to streamline grownup immunizations in HEDIS.

Measure Title

Abstract of Proposed Measure Retirements inside AIS-E

Grownup Immunization Standing (AIS-E)

  • Flu Vaccinations for Adults Ages 18–64 (FVA)
  • Flu Vaccinations for Adults Ages 65 and Older (FVO)
  • Pneumococcal Vaccination Standing for Older Adults (PNU)

Cross-cutting updates

Growth of race and ethnicity stratification in HEDIS

NCQA launched the race and ethnicity stratification to 5 HEDIS measures in MY 2022 and is wanting so as to add a minimum of 5 extra measures in MY 2023. Based mostly on suggestions from skilled panels and exterior stakeholders, the NCQA staff developed a listing of candidate measures for MY 2023 throughout a number of domains and is on the lookout for suggestions on this listing in addition to any others that ought to be thought of.

Area

Measure

Behavioral Well being

Comply with-Up After Emergency Division Visits for

Substance Use Dysfunction (FUA)

Pharmacotherapy for Opioid Use Dysfunction (POD)

Despair Screening and Comply with-Up for Adolescents and Adults (DSF-E)

Utilization of the PHQ-9 to Monitor Despair

Signs for Adolescents and Adults (DMS-E)

Prenatal Despair Screening and Comply with-Up (PND-E)

Postpartum Despair Screening and Comply with-Up

(PDS-E)

Prevention and Screening

Breast Most cancers Screening (BCS-E)

Grownup Immunization Standing (AIS-E)

Immunizations for Adolescents (IMA, IMA-E)

Prenatal Immunization Standing (PRS-E)

Utilization

Nicely-Youngster Visits within the First 30 Months of Life (W30)

Entry and Availability of Care

Initiation and Engagement of Substance Use Dysfunction Remedy (IET)

Respiratory

Bronchial asthma Medicine Ratio (AMR)

Care Coordination

Comply with-Up After Emergency Division Go to for Individuals With A number of Excessive-Danger Persistent Circumstances (FMC)

Able to remark?

NCQA is on the lookout for public feedback on these new proposed HEDIS measures, updates to present measures, proposed measure retirements, and new subjects by 5:00 pm ET, Friday, March 11. Submit your feedback through the NCQA public remark web site.

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Read the fact sheet

HEDIS® is a registered trademark of the Nationwide Committee for High quality Assurance (NCQA).

CAHPS® is a registered trademark of the Company for Healthcare Analysis and High quality (AHRQ).

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