Stratified Measures: How HEDIS Can Enhance Health Equity
October 18, 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.
Slides, a recording and transcript of the October 6, 2022, event are available.
NCQA Manager Keirsha Thompson and Senior Research Associate Sarah Paliani led the
1-hour discussion, which included almost 30 minutes of Q&A.
Highlights of the webinar’s new and most vital information are below.
The Big Idea
Our work to advance health equity builds on three ideas:
- High quality care is equitable care.
- There can be no quality without equity.
- We need to integrate health equity into everything NCQA does.
We see four main ways HEDIS can advance health equity:
- Bring transparency to quality inequities.
- Promote inclusive approaches to measurement and accountability.
- Address social needs to improve health outcomes.
- Incentivize equity with benchmarks and performance scoring.
Expanding Race & Ethnicity Stratification
One of the first and most practical ways we make HEDIS a tool to improve health equity is by stratifying measures by race and ethnicity.
Stratifying measures means checking measure results by members’ race and ethnicity to reveal racial or ethnic care gaps.
HEDIS Volume 2—the best known and most frequently consulted of the HEDIS volumes—explains:
Race is a social construct, not biological; stratifying HEDIS measures by race and ethnicity is intended to further understanding of racial and ethnic disparities in care and to hold health plans accountable to address such disparities, with the goal of achieving equitable health care and outcomes. Data are not to be used to further bias in health care or suggest that race and ethnicity are biological determinants of health.
We stratified five HEDIS measures for measurement year 2022 and will stratify eight more in measurement year 2023.
| Domain | Measure | Measurement Year Stratification Added |
|---|---|---|
| Prevention & Screening | Adult Immunization Status (AIS-E) | MY 2023 |
| Prevention & Screening | Immunization for Adolescents (IMA) | MY 2023 |
| Prevention & Screening | Breast Cancer Screening (BCS) | MY 2023 |
| Prevention & Screening | Colorectal Cancer Screening (COL) | MY 2022 |
| Respiratory | Asthma Medication Ratio (AMR) | MY 2023 |
| Cardiovascular | Controlling High Blood Pressure (CBP) | MY 2022 |
| Diabetes | Hemoglobin A1c Control for Patients With Diabetes (HBD) | MY 2022 |
| Behavioral Health | Follow-Up After Emergency Department Visits for Substance Use (FUA) | MY 2023 |
| Behavioral Health | Pharmacotherapy for Opioid Use Disorder (POD) | MY 2023 |
| Access and Availability of Care | Prenatal and Postpartum Care (PPC) | MY 2022 |
| Utilization | Well-Child Visits in the First 30 Months of Life (W30) | MY 2023 |
| Utilization | Child and Adolescent Well Care Visits (AWC) | MY 2023 |
| Access and Availability of Care | Initiation and Engagement of Substance Use Disorder Treatment (IET) | MY 2023 |
We like this list of 13 measures for its breadth and balance. It spans:
- Seven measure domains.
- A mix of populations.
- A wide range of conditions.
- Varied points along the care continuum—from prevention to follow-up after illness.
We will stratify more measures. Look for our next list of prosed measures to stratify in the annual HEDIS public comment period, coming in February 2023.
There’s much more to learn from our Future of HEDIS webinars. Scroll to Webinar Archives, Episode 12: Using HEDIS to Improve Health Equity.
