HEDIS MY 2025: What’s New, What’s Changed, What’s Retired

August 1, 2024 · NCQA Communications

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is constantly evolving to ensure measures are relevant and represent clinical best practices.

For Measurement Year 2025, NCQA added three HEDIS measures, retired four measures and made smaller changes across multiple measures. We also continue the transition to Electronic Clinical Data Systems (ECDS) reporting.

New HEDIS Measures

The newest additions to HEDIS address the use of Breast Imaging Reporting and Data System (BI-RADS) assessments, abnormal breast cancer assessment follow-up and blood pressure control. All these measures are reported using the ECDS reporting method.

• Documented Assessment After Mammogram*. The percentage of episodes for members 40–74 years of age with mammograms documented in the form of a BI-RADS assessment within 14 days of the mammogram.
  • Intent: This measure addresses the need for timely documentation of breast cancer screening results using the American College of Radiology’s BI-RADS assessment categories. BI-RADS standardizes reporting of findings into six assessment categories for further management.
• Follow-Up After Abnormal Breast Cancer Assessment**. The percentage of episodes for members 40–74 years of age with inconclusive or high-risk BI-RADS assessments that received appropriate follow-up within 90 days of the assessment.
  • Intent: This measure assesses for timely follow-up after inconclusive or high-risk assessments. Successful identification of cancer relies on appropriate follow-up of abnormal results. Failure to complete timely diagnostic testing can undermine the significance of screening. It is estimated that up to 30% of women fail to attend recommended immediate follow-up for high-risk mammograms.[1] Studies have found that delayed time to follow-up after abnormal mammography plays a role in decreased survival rates among underserved minority women.[2] Thus, an opportunity exists to improve breast cancer screening follow-up and reduce the public health burden of this illness.
• Blood Pressure Control for Patients With Hypertension. The percentage of members 18–85 years of age who had a diagnosis of hypertension and whose most recent blood pressure was <140/90 mm Hg during the measurement period.
  • Intent: This new measure has two key modifications from the Controlling High Blood Pressure (CBP) HEDIS measure, which uses the Hybrid reporting method (including medical record review) and a denominator that may miss many people with hypertension who should be included in the measure:

1. 1. 1. It uses the ECDS reporting method.
      2. The denominator includes a pharmacy data method with a hypertension diagnosis.

• • This measure is stratified by race and ethnicity.

Changes to Existing HEDIS Measures

• Eye Exam for Patients With Diabetes. NCQA retired the Hybrid Method; this measure is now reported using the Administrative Method only.
• Follow-Up After Emergency Department Visit for Mental Illness and Follow-Up After Hospitalization for Mental Illness. NCQA updated denominator criteria to include phobia diagnoses, anxiety diagnoses, intentional self-harm X-chapter codes and the R45.851 suicidal ideation code. These measures expanded the numerator criteria with additional follow-up options, including expansion of provider-type options, inclusion of psychiatric residential treatment and peer support services for mental health.
• Use of High-Risk Medications in Older Adults. NCQA is removing and adding medications to this measure, and is regrouping some medications into different “drug classes” in the specifications to align with the updated American Geriatrics Society (AGS) Beers Criteria^®.
• Well-Child Visits in the First 30 Months of Life; Child and Adolescent Well-Care Visits. NCQA is removing telehealth visits; these were added temporarily in response to the COVID-19 pandemic. Removing telehealth well-care visits aligns the measures with updated guideline recommendations.
• Acute Hospital Utilization. NCQA expanded this measure to include the Medicaid product line for members 18–64 years of age. This initiative was motivated by the retirement of the Inpatient Utilization measure in MY 2024, and by NCQA’s commitment to improving quality across diverse populations.
• Adult Immunization Status. NCQA added an indicator assessing hepatitis B immunization for adults 19–59 years of age. NCQA removed the herpes zoster live vaccine from the existing herpes zoster immunization indicator, and revised the numerator criteria to assess receipt of the recombinant zoster vaccine on or after October 1, 2017. For the existing pneumococcal immunization indicator, NCQA updated the denominator age range to assess immunization for adults 65 and older.
• Chlamydia Screening. As part of a cross-cutting project to ensure that HEDIS measures appropriately acknowledge and affirm members’ gender identity, NCQA updated the Chlamydia Screening in Women measure to include transgender members recommended for routine chlamydia screening, and renamed the measure “Chlamydia Screening”.

Cross-Cutting Topics

Race and Ethnicity Stratification Reporting: Stakeholders asked NCQA to refine and/or remove the data source reporting requirement from measures with the race/ethnicity stratification, stating that the requirement adds reporting burden by significantly increasing the number of indicators that must be reported. In response, NCQA removed the data source reporting requirement from stratified measures in MY 2025.

NCQA retained the data source reporting requirement for the Race and Ethnicity Diversity of Membership (RDM) descriptive measure only, to allow transparency into the types of data sources organizations leverage. NCQA refined the data source reporting categories to facilitate ease of reporting; clarified the distinction between member-self reported data and other data types; and clarified the intent of the imputation source category.

ECDS Reporting

NCQA retired the Administrative and Hybrid reporting methods for Childhood Immunization Status, Immunizations for Adolescents and Cervical Cancer Screening. Only the ECDS Method will be used for these measures.

Click here for information about the transition to ECDS reporting.

Retirement

NCQA is retiring the following indicator and measure in order to reduce burden and evolve HEDIS.

• Care for Older Adults. NCQA retired the Pain Assessment indicator because it did not differentiate between acute and chronic pain, require comprehensive assessment or assess for follow-up after assessment. NCQA will monitor the field for evolving evidence, and will consider new measures of pain assessment for older adults in the future.
• Antidepressant Medication Management. While there is broad agreement that medication adherence is an important driver of patient-centered outcomes for depression care, several factors informed retirement of this measure:
  • The measure does not address other guideline-recommended, non-pharmacological components of care.
  • Measure specifications do not adequately capture appropriate clinical judgment to avoid pharmacological treatments.
  • NCQA has a more comprehensive set of measures of depression screening, follow-up and routine monitoring, and improvement in outcomes. NCQA is committed to expanding the use of these measures in reporting programs.

For more information, refer to the full measure specifications in HEDIS MY 2025 Volume 2: Technical Specifications for Health Plans. HEDIS publications are available as electronic publications. To order publications, call 888-275-7585 or visit the NCQA Store.

Join the HEDIS Users Group for an insider’s look at information on HEDIS development and future directions.

* This measure was supported by Cooperative Award NU380T000303 from the Centers for Disease Control and Prevention and the National Network of Public Health Institutes (NNPHI). Its contents are the sole responsibility of the authors (NCQA) and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the US Department of Health and Human Services, the US government, or the NNPHI.

** This measure was supported by Cooperative Award NU380T000303 from the Centers for Disease Control and Prevention and the National Network of Public Health Institutes (NNPHI). Its contents are the sole responsibility of the authors (NCQA) and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the US Department of Health and Human Services, the US government, or the NNPHI.

1 Reece, J.C., E.F.G. Neal, P. Nguyen, J.G. McIntosh, J.D. Emery. April 7, 2021. “Delayed or Failure to Follow-Up Abnormal Breast Cancer Screening Mammograms in Primary Care: A Systematic Review.” BMC Cancer 21(1):373. doi: 10.1186/s12885-021-08100-3. PMID: 33827476; PMCID: PMC8028768.

2 Petersen, S.S., M. Sarkissyan, Y. Wu, S. Clayton, J.V. Vadgama. 2018. “Time to Clinical Follow-up after Abnormal Mammogram among African American and Hispanic Women.” J Health Care Poor Underserved 29(1):448–62. doi: 10.1353/hpu.2018.0030. PMID: 29503311; PMCID: PMC6614556.