NCQA Seeks Public’s Help On New and Revised Measures

Hedis®1 2018 Public Comment is February 22–March 22, 2017

February 22, 2017

Hedis®1 2018 Public Comment is February 22–March 22, 2017

WASHINGTON, D.C.—The National Committee for Quality Assurance (NCQA) invites the public to comment on 2018 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.

NCQA proposes:

  • Six new measures that assess potentially inappropriate use of opioids, follow-up after emergency department visits for patients with multiple chronic conditions, transitions of care for discharged patients, pneumococcal vaccination status, and screening and follow-up for depression and unhealthy alcohol use.
  • Revisions to five existing measures assessing adolescent immunizations, alcohol and other drug dependence and related utilization, readmissions and screening for breast cancer.
  • Potential strategies to address issues that apply across various measures: the use of telehealth in behavioral health measures, socioeconomic status in the Medicare population and how to account for those enrolled in Institutional Special Needs Plans (I-SNP).
  • Proposed updates to the Electronic Clinical Data Systems (ECDS) guidelines.

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.

An important part of developing and updating HEDIS is to provide the opportunity for the public to review and comment on draft measures. NCQA reviews every comment received during public comment and presents results to its 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.

Proposed New Measures

Use of Opioids at High Dosage or From Multiple Providers: Assesses whether health plan members 18 years and older receive long-term opioids at high dose; opioids from multiple prescribers or multiple pharmacies; or long-term, high-dose opioids from multiple prescribers and multiple pharmacies.

Follow-Up After Emergency Department (ED) Visit for People With Multiple Chronic Conditions: Assesses the percentage of ED visits for Medicare members 18 years and older who have multiple chronic conditions and had follow-up service within 7 days of the ED visit.  

Transitions of Care: Assesses the percentage of inpatient discharges for Medicare members 18 years and older who had each of the following during the measurement year: Notification of Inpatient Admission, Receipt of Discharge Information, Patient Engagement After Inpatient Discharge and Medication Reconciliation Post-Discharge.

Depression Screening and Follow-Up for Adolescents and Adults: Assesses the percentage of members 12 years and older who were screened for clinical depression using a standardized tool and, if screened positive, received appropriate follow-up care.

Pneumococcal Vaccination Status for Older Adults: Assesses the percentage of members 65 years and older who have received the recommended series of pneumococcal vaccines: 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine.

Unhealthy Alcohol Use Screening and Follow-Up: Assesses the percentage of members 18 years of age and older who were screened for unhealthy alcohol use using a standardized tool and, if screened positive, received appropriate follow-up care within two months.

Proposed Changes to Existing Measures

Immunizations for Adolescents: NCQA proposes revising the human papillomavirus vaccine rate to align with the updated Advisory Committee on Immunization Practices guidelines, which permit a two-dose vaccination schedule for adolescents.

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment and Identification of Alcohol and Other Drug Services: NCQA proposes adding Medication-Assisted Treatment as an appropriate modality for those with alcohol and opioid dependence, and stratifying the measure rates by alcohol, opioid and other drug dependence diagnosis.

Plan All-Cause Readmissions: NCQA proposes to develop a strategy to include the Medicaid product line in HEDIS 2018 for the Plan All-Cause Readmissions measure.

Breast Cancer Screening: NCQA seeks comments on whether to allow digital breast tomosynthesis to be numerator compliant.

Cross-Cutting Topics

Telehealth: NCQA is seeking public comment on the recommended inclusion of telehealth in seven HEDIS and two proposed behavioral health measures. Recommendations are based on evidence and stakeholder feedback. NCQA is seeking public comment on the proposed approach for evaluating other HEDIS measures outside the behavioral health domain for inclusion of telehealth.

Addressing Socioeconomic Status: There has been persistent attention on the issue of socioeconomic status (SES) and its potential effects on receipt of health services and performance on quality measures. NCQA is exploring whether changes to select HEDIS measures to account for SES are warranted. We seek public comment on a strategy to stratify Medicare plan measure reporting by beneficiary socioeconomic status for the following measures:

  • Colorectal Cancer Screening
  • Breast Cancer Screening
  • Diabetes Eye Exam
  • Plan All-Cause Readmissions

I-SNPs: Medicare members enrolled in I-SNPs are long-term institutional dwelling and have higher levels of morbidity, frailty and cognitive impairment than the general Medicare Advantage population. Quality measures that were designed and intended for a general adult population may not be appropriate for evaluating quality of care in the long-term institutional dwelling population. NCQA seeks public comment on a proposal to exclude individuals who are enrolled in I-SNPs from the following HEDIS measures:

  • Breast Cancer Screening
  • Colorectal Cancer Screening
  • Osteoporosis Management in Women Who Had a Fracture

HEDIS Measures Using Electronic Clinical Data Systems: NCQA seeks comments on proposed updates to the guidelines for measures using ECDS. The focus of ECDS is to encourage better quality through use of electronic data and standardization of reporting protocols, thereby streamlining the quality measure enterprise. Three measures going to public comment are specified using this data collection system.

How to Participate in Public Comment

To read and comment on the proposed changes, visit The public comment period begins at 9:00 AM (EST) on February 22 and ends at 11:59 PM (EST) on March 22. NCQA will review input from public comment and will publish new and updated measures and guidelines in HEDIS 2018, Volume 2, in summer 2017.

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