HEDIS and Cancer Prevention—Updates and New Measures
August 7, 2024 · NCQA Communications
After a positive cancer screen, appropriate and timely follow-up care is important to the success of any treatment plan. With that in mind, NCQA is developing new HEDIS cancer follow-up measures and updating its Breast Cancer Screening measure.
HEDIS measures focused on cancer prevention and early detection can help hold health care organizations accountable for making sure their members are getting needed care.
The Right Age to Start Breast Cancer Screening
Breast Cancer Screening (BCS-E) currently assesses screening starting at age 50. NCQA recently proposed updating the measure to assess screening starting at age 40, to align with revised recommendations from the U.S. Preventive Services Task Force.
NCQA posted the proposed change for public comment in 2023, after the Task Force released its draft recommendations. Now that the Task Force has finalized its recommendations, we plan to bring this change to our committees for a vote this fall.
If the change is approved, NCQA will add the “40–49” age group as a separate rate for all product lines. Any changes made to this measure will be included in the HEDIS MY 2025 Technical Update. NCQA will announce the final decision in the fall.
Two New Breast Cancer Assessment Measures Coming in HEDIS MY 2025
Screening is just the first step in successfully treating cancer; patients also need timely follow-up care after an abnormal screening, to get the right diagnosis and treatment quickly. NCQA is developing measures to assess how well health plans track and provide follow-up.
MY 2025 will include two new HEDIS breast cancer measures: Documented Assessment After Mammogram (DBM-E) and Follow-Up After Abnormal Mammogram Assessment (FMA-E).
- DBM-E looks at data quality and how well health plans capture the scores providers assign to mammogram results in structured data fields.
- FMA-E measures how well plans get members the right follow-up care—whether it’s more screening or additional tests—at the right time, based on mammogram results.
Both measures utilize EHR data, and both will be reported using the Electronic Clinical Data Systems method, which allows plans to report clinical data electronically in a standardized format.
Other Cancer Follow-Up Measures
NCQA’s draft measure for follow-up after abnormal cervical cancer screening results was in public comment earlier this year, but we (and our expert panels) determined that the measure is not yet ready for HEDIS because no data standards match the precise clinical concepts in the clinical guidelines.
Looking Ahead
NCQA will revisit the cervical cancer screening follow-up measure in the future, and will evaluate developing other follow-up measures—for cancers and other conditions—as data interoperability and analytic capabilities allow us to evolve quality measures across the care continuum.
Learn more about the changes to HEDIS MY 2025 here.
