Yes. Replace the reference to “date/time” in the first bullet in the Note section with “date.”
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11.15.2017
Transitions of Care The HEDIS 2018 Volume 2 Technical Update memo indicates the following change in the Transitions of Care specifications: In the first sentence of the third paragraph, replace “date/time” with “date.”
Should this change also apply to the first bullet in the “Note” section of the technical specifications that reads, “The following notations or examples of documentation do not count as numerator compliant:
*Documentation of notification that does not include a time frame or date/time stamp.”
11.15.2017 Guidelines for Calculations and Sampling The footnote on page 45 of HEDIS 2018 Volume 2 indicates that the lowest Prior Year rate from “Prenatal and Postpartum Care” and “Frequency of Prenatal Care” should be used to reduce the sample size for PPC. Given that FPC was retired with the HEDIS 2018 Volume 2 Technical Update, should the PPC MRSS use the lower rate of the Postpartum and Prenatal care indicators?
Yes. With the retirement of the FPC measure, organizations may reduce the sample size for the PPC measure using the lowest rate of the 2 indicators from the current year’s administrative rate or the prior year’s audited, product line-specific rate.
This applies to the following Programs and Years:
HEDIS 201811.09.2017 Additional Resources Are there any outside resources that may help me in the PCMH transformation process?
| Content Area | Criteria | Resource Link | Description |
| TC | 02 | http://www.ihi.org/resources/Pages/Changes/OptimizetheCareTeam.aspx | Resource on how to optimize staff responsibilities |
| 02 | https://www.integration.samhsa.gov/operations-administration/OATI_Tool3_ART.pdf | Toolkit on how to optimize administrative staff responsibilities to benefit clinical practice | |
| 02 | http://www.improvingprimarycare.org/team/pcp | Resource on how to optimize staff responsibilities | |
| 04 | https://www.stepsforward.org/modules/pfac | Module teaching how to create a patient advisory council | |
| 07 | http://www.nachc.org/research-and-data/prapare/toolkit/ | Toolkit to better understand social determinants of health | |
| 08 | https://integrationacademy.ahrq.gov/sites/default/files/AHRQ_AcademyGuidebook.pdf | Information on behavioral healthcare integration in primary practice | |
| KM | 02 G | https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/ | Social needs screening toolkit |
| 12 | https://www.cdc.gov/media/releases/2012/p0614_preventive_health.html | Discussion on benefits of preventative care | |
| 14 | https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/match/match.pdf | Guide to medication reconciliation at transitions | |
| 16 | http://www.teachbacktraining.org/ | Information on teach back training | |
| 17 | http://www.improvingprimarycare.org/work/medication-management | Guide to medication management | |
| 24 | https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/index.html | Toolkit for shared decision making | |
| 24 | http://msdmc.org/3-assess/ | Toolkit for shared decision making | |
| 24 | https://shareddecisions.mayoclinic.org/ | Informative website about shared decision making | |
| 13 | http://www.jabfm.org/content/28/2/170.full.pdf | "Patient Empanelment: The Importance of Understanding Who Is at Home in a Medical Home" | |
| AC | 13 | http://www.annfammed.org/content/10/5/396.full | "Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation" |
| http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/aug/1764_hong_caring_for_high_need_high_cost_patients_ccm_ib.pdf | Article discussing benefits and strategies to care management | ||
| CM | 03 | https://nf.aafp.org/Shop/practice-transformation/risk-stratified-care-mgmt-rubric | Risk stratification rubric available to members of the AAFP |
| 03 | http://www.calquality.org/storage/documents/cqc_complexcaremanagement_toolkit_final.pdf | Risk stratification rubric from California Quality Collaborative | |
| 03 | http://www.millimanriskadjustment.com/ | MARA – The Milliman Advanced Risk Adjuster is a model of risk stratification in which risk scores are normalized to a given population. | |
| 04 | http://www.aafp.org/fpm/2015/0100/fpm20150100p7-rt1.pdf | Care Plan template from AAFP, not exclusive to members | |
| 06 | http://www.dartmouthatlas.org/downloads/reports/preference_sensitive.pdf | Resource on how to incorporate patient preference into care management | |
| 08 | http://www.ihi.org/resources/pages/tools/selfmanagementtoolkitforclinicians.aspx | Toolkit to aid clinicians in promoting self-management | |
| 08 | https://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/index.html | Resources on self management | |
| 08 | http://champsonline.org/tools-products/clinical-resources/patient-education-tools/patient-self-management-tools | Condition specific self management tools | |
| 08 | https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/ | Article discussing proper communication between primary and specialist clinicians | |
| CC | 14 | http://nihcr.org/analysis/improving-care-delivery/prevention-improving-health/ed-coordination/ | Information on improving communication between emergency and primary physicians |
| 16 | https://share.kaiserpermanente.org/article/kaiser-permanente-study-finds-tailored-post-hospital-visits-lower-risk-readmission-medicare-advantage-patients/ | Article discussing advantages of post hospital primary care visits | |
| QI | https://www.ahrq.gov/sites/default/files/publications/files/pcmhqi2.pdf | Resource for building quality improvement in primary care | |
| 03 | http://www.ihi.org/resources/Pages/Measures/ThirdNextAvailableAppointment.aspx | Information on how to utlize third next available appointment measurement | |
| 08 | https://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod4.html | Benefits of PDSA cycle |
This applies to the following Programs and Years:
PCMH 201710.15.2017 ECDS What file formats are acceptable for transmitting data between the plan and the care team at the point of service?
NCQA does not specify file formats for exchanging clinical information, but strongly encourages adherence to Health Level Seven International (HL7) standards for clinical document exchange (e.g., QRDA, CCD) and electronic health care information exchange (e.g., FHIR).
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS For IP-ECDS coverage, does NCQA look for the number of members in the initial population?
IP-ECDS coverage count includes all members in the initial population who are being managed by at least one provider with the capacity to send, receive and use electronic data for quality improvement purposes.The Initial Population includes all members (covered and not covered by ECDS) who are identified as eligible for the measure reported by the data source category used to determine eligibility.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS What HEDIS Effectiveness of Care measures will move to ECDS?
NCQA is evaluating existing HEDIS measures, eCQMs and other de novo measure concepts for inclusion in the ECDS domain. Selected measures will be reengineered and retested, as necessary, and must be approved by the CPM before their release in ECDS, consistent with other HEDIS measures.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS What does NCQA mean by “information has to be accessible by the health care team at the point of care”?
To qualify for HEDIS ECDS reporting, practitioners and practitioner groups that are accountable for clinical services provided to members must have access to data used by plans for quality measure reporting, regardless of the SSoR.
NCQA does not currently specify a method of data access, but a core principle of ECDS reporting is that the information needed to deliver the highest-quality care must be available to the entire health care team responsible for managing a member’s health.
Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system. The care team’s ability to access data must be documented, to provide evidence that information is available whether or not it is accessed.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS Does the denominator only include plan members covered by ECDS who are in the initial population?
10.15.2017 ECDS What is the IP-ECDS Coverage Rate threshold for public reporting of ECDS measure results?
Organizations do not report an IP-ECDS coverage rate; they report a count of members in the initial population covered by ECDS. NCQA does not publicly report these data, which are for internal NCQA use and for benchmarking analysis to help determine the timeline for public reporting.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS How are ECDS different from supplemental data?
The ECDS reporting method uses much of the same data classified as supplemental for other HEDIS measures, but ECDS measures adhere to different reporting rules from those in other HEDIS domains. Unlike supplemental data used for HEDIS, data for ECDS reporting are classified by source and are used to report all measure elements (e.g., denominator, exclusions, numerator).
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS May we use claims for ECDS reporting?
Administrative claims are considered an ECDS data source if the payment system is automated and data are accessible by the practitioner/practitioner group that is accountable for clinical services provided to plan members (e.g., if claims are used to identify an inpatient stay, the primary care provider must be able to access the details of the stay). Report all measure results identified by claims in the “Administrative claims” source system of record (SSoR) category.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS How are ECDS measures different from the eMeasures in Meaningful Use?
HEDIS ECDS and eClinical Quality Measures (eCQM) developed for Meaningful Use are specified using the same data standards. eCQMs are specifically designed to use data extracted from an EHR, and HEDIS ECDS measures use multiple data sources to complete the picture of member experience across the care continuum.
