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.

DomainMeasureMeasurement Year
Stratification Added
Prevention & ScreeningAdult Immunization Status (AIS-E)MY 2023
Prevention & ScreeningImmunization for Adolescents (IMA)MY 2023
Prevention & ScreeningBreast Cancer Screening (BCS)MY 2023
Prevention & ScreeningColorectal Cancer Screening (COL)MY 2022
RespiratoryAsthma Medication Ratio (AMR)MY 2023
CardiovascularControlling High Blood Pressure (CBP)MY 2022
DiabetesHemoglobin A1c Control for Patients With Diabetes (HBD)MY 2022
Behavioral HealthFollow-Up After Emergency Department Visits for Substance Use (FUA)MY 2023
Behavioral HealthPharmacotherapy for Opioid Use Disorder (POD)MY 2023
Access and Availability of CarePrenatal and Postpartum Care (PPC)MY 2022
UtilizationWell-Child Visits in the First 30 Months of Life (W30)MY 2023
UtilizationChild and Adolescent Well Care Visits (AWC)MY 2023
Access and Availability of CareInitiation 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.

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