Social Need: New HEDIS Measure Uses Electronic Data to Look at Screening, Intervention
November 2, 2022 · Andy Reynolds
Episode 12 in NCQA’s longest and best attended webinar series, The Future of HEDIS, focused on how quality advocates can use HEDIS to investigate, illuminate and elevate health equity.
Highlights of the webinar’s new and most vital information are below.
Beginning in 2023, HEDIS will tackle the unmet social needs of health plan members with our new Social Need Screening and Intervention (SNS) measure.
“Health is about more than just clinical or behavioral factors,” says Sarah. “A substantial contribution to health outcomes may be social factors.” Our new measure targets social factors that drive many disparities in care and outcomes.
The SNS measure will use electronic data to look at screening and intervention. Health plans will report the measure using NCQA’s newest method, the Electronic Clinical Data Systems (ECDS) reporting standard, which lets plans report structured clinical and administrative data directly from their electronic systems.
ECDS is one of four methods health plans use to report HEDIS measures.
|Administrative: Transaction Data||Enrollment, Claims, Encounter|
|Hybrid: Administrative + Sample||Manual Medical Record Review|
|Survey||CAHPS®, Medicare Health Outcomes Survey|
|ECDS||Enrollment, Claims, Encounter, EHRs, Registries, Case Management|
How the SNS Measure Works
The SNS measure looks at six indicators, one each for screening and intervention across three social needs. It measures the percentage of members who, during the measurement period, were:
- Screened via a pre-specified instrument at least once for unmet needs related to
- Members who screen positive receive a corresponding intervention.
The measure applies to all age ranges, and reporting is stratified by age, although members are excluded from the measure if they are:
- In hospice.
- Enrolled in institutional special needs plans.
- In long term care.
The SNS denominator and numerators are defined as:
- Denominator: Health plan members of any age (excepting excluded members).
- Numerators: Members in the denominator who have at least one documented result on a screening instrument for food, housing and transportation. Screenings from a list of pre-specified instruments count toward the numerator.
Intervention indicators assess the percentage of members who screened positive for food, housing or transportation and received a corresponding intervention within 30 days of the positive screen. Interventions fall into eight categories:
- Evaluation of eligibility.
Where to Find the New Measure
Look for the new social needs measure and its narrative specification in the ECDS-reported measures section of HEDIS Volume 2: Technical Specifications for Health Plans.
The SNS measure aligns with current Gravity Project data elements, a national, multistakeholder initiative that:
- Develops consensus-based standards related to social determinants of health.
- Identifies which data elements need to be captured and exchanged electronically.
- Develops a common vocabulary to support electronic exchange of data.
NCQA is eyeing measurement of additional high-priority social need domains such as social connection—and there might be others.