New HEDIS Measures? We’re Glad You Asked!

July 7, 2016 · NCQA Communications

New HEDIS measures? Yep, and we’re glad you asked! There’re some new and revised measures in HEDIS this year. But let’s start with a quick primer.

HEDIS Measures Updates

HEDIS Measures Updates

NCQA released the first Healthcare Effectiveness Data and Information Set (HEDIS®) in 1993 and it’s become the national standard for health plan performance reporting. Today, more than 90 percent of America’s health plans use HEDIS to measure performance on areas of care and service such as controlling high blood pressure and comprehensive diabetes care.

HEDIS is revised every year and this week NCQA released the 2017 HEDIS updates. There are four new measures, changes to existing measures and two measures combined to create one.

New HEDIS Measures

Standardized Healthcare-Associated Infection Ratio: This measure looks at data from CMS’ Hospital Compare and gauges the risk of potential infection exposure in hospitals. This is the first time NCQA is using this type of data collected from thousands of acute care facilities, represent hospital network safety at the health-plan level.

Follow-Up After Emergency Department Visit for Mental Illness: This measure assesses the percentage of emergency department (ED) visits for those 6 years of age and older with a principal diagnosis of mental illness, who had a follow up visit for mental illness within seven and 30 days of the ED visit.

Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence: This measure evaluates the percentage of ED visits for people 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) dependence, who had a follow up visit for AOD within seven and 30 days of the ED visit.

Depression Remission or Response for Adolescents and Adults: This measure gauges the percentage of people 12 years of age and older with a diagnosis of depression who had evidence of response or remission within five to seven months. This patient-reported outcome measure pulls data from electronic clinical data systems (ECDS) for health plan reporting.

Changes to Existing HEDIS Measures

Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly: NCQA updated the medications included in these two measures to align with the American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Additionally, NCQA:

  • Revised one reporting rate to assess at least two dispensing events for the same high-risk medication in Use of High-Risk Medications in the Elderly.
  • Revised the exclusion criteria for the History of Falls and Dementia rates in the Potentially Harmful Drug-Disease Interactions measure so that individuals with delirium may be included.

Fall Risk Management: This measure is collected using the Medicare Health Outcomes Survey (HOS) and includes two rates: Discussing Fall Risk and Managing Fall Risk. NCQA expanded the age range in the Discussing Fall Risk rate to include all Medicare members 65 years of age and older, and revised the examples in the Managing Fall Risk rate.

Pneumococcal Vaccination Status for Older Adults: NCQA revised the current Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®2) survey question about vaccination for pneumococcal disease, to better align with the updated Advisory Committee on Immunization Practices (ACIP) guidelines recommending adults 65 and older receive two different pneumococcal vaccines.

Use of Imaging Studies for Low Back Pain: NCQA updated this overuse/ appropriateness measure for members 18–50 years of age to exclude those who have prolonged use of corticosteroids, HIV, major organ transplant or spinal infection. The updated version shortens the look-back period for recent trauma claims from 12 months to 3 months; and adds physical therapy and telehealth visits as a way to identify members with low back pain in the denominator.

Immunizations for Adolescents and Human Papillomavirus Vaccine for Female Adolescents: NCQA previously evaluated adolescent vaccines using two separate measures. The Human Papillomavirus for Female Adolescents measure, developed before the HPV vaccine was recommended for males, assessed female adolescents who received three doses of the HPV vaccine by age 13. The Immunizations for Adolescents measure looks at all adolescents given the meningococcal and Tdap vaccines by age 13. These two measures were combined in a single measure that reports all recommended vaccines (meningococcal, Tdap, HPV) for female and male adolescents. These vaccines are recommended for routine administration for adolescents and are important for preventive health and cancer prevention.

For more information, refer to the full measure specifications in HEDIS 2017, Volume 2. HEDIS publications are available in print and electronically. To order, call 888-275-7585 or visit NCQA’s Publications Web page at

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