FAQ Directory: HEDIS

Filter Results
  • Save
  • Email
  • Print
expand all

10.15.2017 ECDS What does NCQA mean by “information has to be accessible by the health care team at the point of care”?

To qualify for HEDIS ECDS reporting, practitioners and practitioner groups that are accountable for clinical services provided to members must have access to data used by plans for quality measure reporting, regardless of the SSoR.

NCQA does not currently specify a method of data access, but a core principle of ECDS reporting is that the information needed to deliver the highest-quality care must be available to the entire health care team responsible for managing a member’s health.

Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system. The care team’s ability to access data must be documented, to provide evidence that information is available whether or not it is accessed.

HEDIS 2018

10.15.2017 ECDS Will ECDS measures be used for Health Plan Accreditation or ratings?

ECDS measures are currently not approved for public reporting by NCQA, and are not eligible for use in HPA or health plan ratings. All measures must be approved for public reporting by the Committee on Performance Measurement (CPM) before they can be considered for inclusion in an NCQA program.

HEDIS 2018

10.15.2017 ECDS Clarify “data must be accessible by the health care team at point of care.”

To qualify for HEDIS ECDS reporting, practitioners/practitioner groups that are accountable for clinical services provided to members must be able to access all ECDS data used by a health plan for quality measure reporting.Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system.

HEDIS 2018

10.15.2017 ECDS If a plan wants to use its internal case management system as a data source, must there be evidence that data were shared with the provider?

To use a case management system for ECDS reporting, the system must be verified by an NCQA-Certified auditor and demonstrate (e.g., policies and procedures) that all health care providers responsible for managing a member’s condition have access to information. It is not necessary to track whether the information was accessed, but there must be evidence that data are available on request.

HEDIS 2018

10.15.2017 ECDS What auditing process and documentation are required for ECDS sources?

The audit process for HEDIS ECDS measures is evolving. Data sources fall under audit requirements for standard supplemental data. Plans complete a Roadmap for each data source so the NCQA-Certified auditor is aware of all data that are being considered for reporting. Auditors validate policies and procedures for each data source (e.g., file layout, mapping). Although primary source verification is not required, auditors may want to validate the primary source during an initial review of data, to ensure accuracy and validity.

HEDIS 2018

10.15.2017 ECDS What is the IP-ECDS Coverage Rate threshold for public reporting of ECDS measure results?

Organizations do not report an IP-ECDS coverage rate; they report a count of members in the initial population covered by ECDS. NCQA does not publicly report these data, which are for internal NCQA use and for benchmarking analysis to help determine the timeline for public reporting.

HEDIS 2018

10.15.2017 Unhealthy Alcohol Use Screening and Follow-Up In the updated measure specification that was released with the HEDIS 2018 Volume 2 Technical Update, the Data Elements table includes a stratification for ages 44-64. Should this age stratification be 45-64?

Yes. The correct age stratifications are 18-44, 45-64, 65+.

HEDIS 2018

10.15.2017 ECDS Are all data used to determine member compliance with the denominator, numerator or exclusion required to come from an ECDS, or may data from multiple sources be used?

10.15.2017 Use of Opioids at High Dosage and Use of Opioids From Multiple Providers Step 2 of the UOD and UOP eligible population states to exclude “members who had only a single opioid medication (Opioid Medications List) dispensing event.” Does a member who had multiple prescriptions (for the same or different medications) on the same date of service (with no prescriptions on other dates of service during the measurement year) meet criteria for exclusion?

Yes. The intent is to exclude members who were dispensed opioids on only one date of service during the measurement year. If the member had multiple prescriptions (for the same or different medication) on one date of service and had no opioid prescriptions on another date of service during the measurement year, the member is excluded.

HEDIS 2018

10.15.2017 ECDS Are there standard guidelines for how an auditor determines and approves an ECDS database and the amount of provider accessibility needed?

There are no specific ECDS guidelines for auditor approval of ECDS data sources. Data sources must meet the ECDS requirements and must be reputable—containing accurate, complete and reliable clinical data. Auditors use the same validation methods as for all other data sources. For example, for claims data, auditors validate the accuracy and completeness of the plan’s claims data. For a case management system, auditors review the system, the processes for capturing data and whether data can be extracted from the system. NCQA will add guidance to audit requirements as we learn more about data sources being used.

HEDIS 2018

10.15.2017 ECDS What file formats are acceptable for transmitting data between the plan and the care team at the point of service?

NCQA does not specify file formats for exchanging clinical information, but strongly encourages adherence to Health Level Seven International (HL7) standards for clinical document exchange (e.g., QRDA, CCD) and electronic health care information exchange (e.g., FHIR).

HEDIS 2018

10.15.2017 ECDS How are ECDS different from supplemental data?

The ECDS reporting method uses much of the same data classified as supplemental for other HEDIS measures, but ECDS measures adhere to different reporting rules from those in other HEDIS domains. Unlike supplemental data used for HEDIS, data for ECDS reporting are classified by source and are used to report all measure elements (e.g., denominator, exclusions, numerator).

HEDIS 2018