February 12, 2019
WASHINGTON, D.C.—The National Committee for Quality Assurance (NCQA) invites the public to comment on proposed updates to the Healthcare Effectiveness Data and Information Set (HEDIS) measures. This is an opportunity for health plans, purchasers, consumers and other stakeholders to weigh in on the relevance, scientific soundness and feasibility of new and revised measures and to provide input on HEDIS guidelines.
NCQA seeks comments on the following:
- Retiring five measures.
- Shortening the HEDIS Health Plan CAHPS®2 (CAHPS 5.0H) Survey.
- New HEDIS measures assessing substance use disorder and prenatal and postpartum depression care.
- Revisions to several measures.
- Proposed changes that apply across multiple measures.
About HEDIS and Public Comment
HEDIS comprises measures of clinical quality and patient experience that are based on published clinical guidelines and published scientific evidence. When clinical guidelines change, or new evidence becomes available in the scientific literature, NCQA reviews HEDIS measures to determine whether changes may be needed. NCQA convenes multi-stakeholder advisory groups—including independent scientists, clinicians, consumers and purchasers—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.
Public review and comment is an important part of developing, updating and retiring HEDIS measures. NCQA reviews all comments received during public comment and presents results to multi-stakeholder advisory groups and the NCQA Committee on Performance Measurement for deliberation.
NCQA’s HEDIS measures do not constitute clinical practice guidelines, nor should they be used to determine insurance or coverage.
Measures Proposed for Retirement
Ambulatory Care: Summarizes utilization of ambulatory care in outpatient visits and emergency department visits.
Inpatient Utilization—General Hospital/Acute Care: Summarizes utilization of acute inpatient care and services in maternity, surgery, medicine and total inpatient.
Rationale: Several existing HEDIS measures encompass most of the same components addressed by these measures.
Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis: Assesses whether adults diagnosed with rheumatoid arthritis were dispensed a disease-modifying anti-rheumatic drug (DMARD).
Rationale: The latest research indicates that about 10%–15% of patients with rheumatoid arthritis can achieve sustained DMARD-free remission, but due to limitations identifying these patients using claims data, these patients cannot be removed from the measure, raising evidence and validity concerns.
Osteoporosis Testing in Older Women: This measure, collected in the Medicare Health Outcomes Survey, assesses women 65–85 years of age who report ever having received a bone mineral density test on their back or hip to screen for osteoporosis.
Rationale: There are concerns about the validity of capturing the specific evidence-based tests recommended for osteoporosis screening using a survey question.
Use of Multiple Concurrent Antipsychotics in Children and Adolescents: Assesses youths on antipsychotics who are prescribed more than one antipsychotic concurrently.
Rationale: The prevalence of multiple antipsychotic use among children and adolescents is extremely low, with little variability in performance demonstrated across plans.
CAHPS Health Plan Survey 5.0H: NCQA seeks feedback on removing four measures from the HEDIS Health Plan CAHPS (CAHPS 5.0H) Survey.
Rationale: The questions proposed for removal demonstrate low reliability.
Proposed New Measures
Follow-Up After High Intensity Care for Substance Use Disorder: Assesses whether adolescents and adults with a high-intensity treatment for substance use disorder (SUD) received a follow-up visit or service for SUD.
Importance: SUDs are a significant contributor to morbidity and mortality. Although clinical guidelines recommend follow-up care after “high-intensity” treatment, few individuals receive any treatment or follow-up care.
Pharmacotherapy for Opioid Use Disorder: Assesses new opioid use disorder (OUD) pharmacotherapy episodes that result in 180 or more covered treatment days among adolescents and adults with a diagnosis of OUD.
Importance: Research suggests that the use of pharmacotherapy can improve outcomes for those with OUD and adherence to pharmacotherapy is critical to prevent relapse and overdose.
Prenatal Depression Screening and Follow-Up: Assesses whether women were screened for clinical depression during pregnancy, and whether those who screened positive received follow up.
Postpartum Depression Screening and Follow-Up: Assesses whether women were screened for clinical depression within 12 weeks post-delivery, and whether those who screened positive received follow-up.
Importance: Depression is a common condition among pregnant and postpartum women and affects both mothers and infants. Guidelines recommend screening all pregnant and postpartum women for clinical depression and establishing follow‐up for those who screen positive. These measures highlight opportunities for improving depression care during these critical periods.
Proposed Changes to Existing Measures
Adherence to Antipsychotic Medications for Individuals With Schizophrenia: Although schizophrenia has a low prevalence, it has wide-reaching consequences for individuals in terms of quality of life. Evidence supports antipsychotic medication adherence to avoid consequences such as greater risk of relapse, hospitalization and suicide. NCQA proposes to add the Medicare and commercial product lines, in addition to expanding the measure to include adults 19 years of age and older.
Antibiotic Measures: Clinical guidelines recommend strongly against the use of antibiotics to treat viral respiratory conditions at all ages. NCQA proposes to expand the age ranges and product lines for Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis, Appropriate Treatment for Children With Upper Respiratory Infection and Appropriate Testing for Children With Pharyngitis. Additionally, NCQA proposes other structural changes for better identification of inappropriate antibiotic prescribing events.
Care for Older Adults—Functional Status Assessment: Optimizing functional status is a cornerstone of high-quality care for older adults. NCQA proposes removing one of four current options for satisfying this indicator to reduce burden and confusion while encouraging standardization in documentation consistent with current practice.
Cervical Cancer Screening: Early detection of cervical cancer can greatly improve treatment outcomes. NCQA proposes to add high-risk human papillomavirus testing as a primary screening option, to align the measure with updated recommendations.
Safe and Judicious Use of Antipsychotics in Children and Adolescents: This measure set evaluates appropriate prescribing and care management for youths on antipsychotic medications. For Metabolic Monitoring for Children and Adolescents on Antipsychotics, NCQA proposes to monitor blood glucose and cholesterol testing separately, to improve interventions and care. NCQA proposes to combine the 1–5 years and 6–11 years age strata in Metabolic Monitoring and Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics measures to improve reportability.
Osteoporosis Management in Women Who Had a Fracture: The intent of this measure is to prevent future fractures in women who have experienced a fragility fracture. NCQA proposes to assess all fractures during the measurement period, not just the first fracture, to remove SEXA as a bone mineral density test and to remove calcitonin from the list of medications.
Prenatal and Postpartum Care: Perinatal visits represent important opportunities to provide evidence-based care. NCQA proposes to replace the current postpartum rate in this measure with three rates: Early Postpartum Visit, Later Postpartum Visit and Early and Later Postpartum Visit. These changes align the timing of visits with newly published recommendations.
Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly: These two measures assess potentially inappropriate medication use in older adults. NCQA proposes updating the medications included in both measures to align with updated recommendations. Additionally, NCQA proposes retiring the rate assessing one dispensing event of high-risk medications, to focus Use of High-Risk Medications in the Elderly on riskier, more long-term use of potentially inappropriate medications. NCQA also proposes to exclude members with major depressive disorder from the History of Falls rate in Potentially Harmful Drug-Disease Interactions in the Elderly because the benefits of prescribing antidepressants may outweigh the potential harms of increased risk of falls.
Use of Opioids at High Dosage: Assesses adults at risk for high-dose opioid use. NCQA proposes lowering the high-dosage threshold from >120 MME (morphine milligram equivalents) to ≥90 MME, to align with CDC recommendations. NCQA also proposes modifying the start date for the opioid treatment period to begin on the first day in the year that a member was dispensed a prescription opioid, rather than the first day the average daily dosage exceeded the MME threshold. These revisions would reduce potential confusion in the field by improving alignment of the HEDIS measure with the Pharmacy Quality Alliance measure from which it was adapted.
Cross-Cutting Topics
Telehealth: NCQA recommends including telehealth in selected HEDIS physical health measures. Recommendations are based on a review of research literature and stakeholder input.
Digital Measure Strategy: NCQA seeks public comment on our approach to gradually add digital formats to HEDIS measures and to add the Electronic Clinical Data Systems reporting standard to three existing measures for voluntary reporting alongside traditional reporting: Breast Cancer Screening, Colorectal Cancer Screening and Follow-Up Care for Children Prescribed ADHD Medication. These efforts are part of NCQA’s strategy to encourage clinical data exchange and to move toward measures that improve our ability to measure the quality of health care.
How to Participate in Public Comment
To read and comment on the proposed changes, visit www.ncqa.org/about-ncqa/contact-us/public-comments/. The public comment period begins at 9:00 AM (ET) on February 11 and ends at 11:59 PM (ET) on March 11. NCQA will review input from public comment and will publish new and updated measures in HEDIS 2020.