February 22, 2006

New HEDIS® Measures Allow Purchasers, Consumers to Compare Health Plans’ Resource Use in Addition to Quality

New patient safety, diabetes measures also included in HEDIS 2007;
public comment through March 22

WASHINGTON—The National Committee for Quality Assurance (NCQA) today released for public comment proposed new measures for inclusion in its Health Plan Employer Data and Information Set (HEDIS®), the tool used by most of the health care industry to measure health plan performance.  Notable among the proposed additions are a set of economic measures that will allow purchasers and consumers to compare how much plans spend on care delivery, in addition to how well they rate in clinical quality. The new Relative Resource Use measures will focus on six high-cost conditions—including cardiac care, diabetes and asthma—that account for 50 to 60 percent of all direct medical expenses. The measures will enable standardized, risk-adjusted assessments of efficiency.

Other new HEDIS measures proposed for 2007 include a patient safety measure that assesses how well prescriptions are managed in the elderly population, and two new measures of diabetes care. 

“Health care costs are rising, resources are limited and 46 million Americans are uninsured. I can’t think of a stronger argument for demanding value from our health system,” said NCQA President Margaret E. O’Kane. “These new measures will allow purchasers to compare plans on both quality and cost. This makes for a much clearer picture of what you’re buying, not just what you’re paying.”

Purchasers praised the new measures. “Making the right purchasing decision involves factoring in a mix of cost and quality measures—but there are no standardized data sets on network costs that allow us to make apples-to-apples comparisons,” said Helen Darling, President of the National Business Group on Health. “These new HEDIS measures are a strong step in the right direction.” 

Interested parties are encouraged to comment on the draft through March 22. The new measures proposed for 2007 include:

• Six Relative Resource Use measures that provide standardized, risk-adjusted measures of efficiency, allowing for national benchmarking of utilization patterns. Diabetes, cardiac conditions, asthma, cardiac obstructive pulmonary disorder (COPD), uncomplicated hypertension and acute low back pain will be separately measured; these six conditions account for 50 to 60 percent of all direct medical expenses.
   
• Potentially Harmful Drug-Disease Interactions in the Elderly, a patient safety measure developed in partnership with the Centers for Medicare & Medicaid Services and with the expertise of NCQA’s  Geriatrics Measurement Advisory Panel, assesses whether elderly patients diagnosed with certain chronic conditions receive contraindicated medications. Studies indicate that between 5 and 35 percent of seniors suffer one or more adverse drug reactions, and over 20 percent are prescribed potentially harmful medicines.
   
• Two new Comprehensive Diabetes Care measures assess whether members with diabetes have their blood pressure controlled to 135/85, and whether their HbA1c levels are controlled to less than 7 percent, the nationally accepted standard of adequate HbA1c control. 
   

Physicians applauded the new patient safety measure. “For seniors who live with chronic conditions such as peptic ulcers or renal disease, there are some medications that simply need to stay on the shelf,” said Meghan Gerety, M.D., Chair of the Board of Directors, American Geriatric Society. “Prescribing the right medications will lower avoidable hospitalizations and reduce serious complications such as hip fractures and depression.” 

With the release of the 2007 draft, NCQA also requests comments on its proposal to change a number of existing HEDIS measures.  Notable among them are specification changes to the Breast Cancer Screening and Cervical Cancer Screening measures. Additionally, two measures assessing whether members with diabetes or cardiac conditions have their LDL cholesterol controlled to less than 130 mg/dL are proposed for retirement, to be replaced by measurement of control to 100 mg/dL. 

HEDIS 2007 will also introduce the use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) version 4.0H. Administered by the Agency for Healthcare Research and Quality, CAHPS is the national standard for measuring and reporting consumer health plan experience. The new version features a streamlined set of core survey questions on access and service, and incorporates questions related to NCQA’s Quality Plus initiative. 

The new measures were developed with the input of NCQA’s Committee on Performance Measurement, which comprises a wide range of health care thought leaders, including physicians, purchasers, consumers, labor and plan representatives. As with all first-year HEDIS measures, data for the new measures will be collected, reported and audited in 2007; however, the results of the first year of measurement will not be publicly reported. 

Relevant sections of the HEDIS 2007 draft can be downloaded from NCQA’s Web site at http://www.ncqa.org/.  Those who wish to comment on the new measures may do so by sending an e-mail to hediscomment@ncqa.org.   

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. 
 

HEDIS® is a registered trademark of the National Committee for Quality Assurance. All rights reserved.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality. All rights reserved.