HEDIS Measures Used by Centers for Medicare and Medicaid Services

January 7, 2016 · NCQA Communications

HEDIS Measures

At NCQA, we are all about measuring quality. In fact, NCQA developed the Healthcare Effectiveness Data and Information Set—HEDIS®—used by the federal government and other stakeholders to assess data in core sets of health care quality measures, which help improve health care across the board.

The Centers for Medicare & Medicaid Services (CMS) has two core sets of measures that assess the quality of health care provided to children and adults enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), with the following goals:

  • Encourage national reporting by states on a uniform set of measures.
  • Support states in using these measures to drive quality improvement.

Toward that end, NCQA applauds the recent addition of two NCQA HEDIS measures to the Medicaid Child and Adult Core Sets:

  1. Use of Multiple Concurrent Antipsychotics in Children and Adolescents.
  2. Diabetes Screening for People With Schizophrenia/Bipolar Disorder Who Are Using Antipsychotic Medications.

How will these two HEDIS measures make a difference?

Use of Multiple Concurrent Antipsychotics in Children and Adolescents allows CMS and states to expand the measurement of quality of care for children prescribed antipsychotic drugs. This is important because antipsychotic prescribing for children has increased rapidly in recent decades, and although evidence shows that it can be successful, less is known about the safety and effectiveness of prescribing patterns that involve combinations of medications with long durations of use. Studies have shown that multiple concurrent antipsychotics may cause side effects such as weight gain and metabolic disturbances, which can affect a child’s development and future health.

With Diabetes Screening for People with Schizophrenia/Bipolar Disorder Who Are Using Antipsychotic Medications, CMS and states can assess the quality of care in Medicaid for adults with schizophrenia/bipolar health disorders. The concerns for diabetes among this population is clear. People with serious mental illness who use antipsychotics are at increased risk of diabetes and have a 50% higher risk of death than diabetics without a mental illness. Therefore, screening and monitoring of patients with schizophrenia/ bipolar disorder is critically important.

Lack of appropriate diabetes care for people with schizophrenia/bipolar disorder can lead to worsening health and death. Addressing the physical health needs of people with these mental health disorders is an important way to improve overall health and future economic outcome.

These newly added measures to the Medicaid Child and Adult Core Sets will take effect before the end of 2016.


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