HEDIS 2016 Public Comment Now Open

February 19, 2015 · NCQA

Provide your feedback by March 18, 2015

NCQA invites the public to comment on 2016 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 guidelines.

NCQA proposes:

• Three new measures on depression care in adolescents and adults.
• Two new measures on hospital and emergency department utilization.
• Two new measures on statin therapy.
• One new measure on hospitalization for potentially preventable complications.
• The reevaluation of two asthma medication measures.
• The reevaluation of a medication reconciliation measure.
• The retirement of the appropriate use of asthma medications measure.
• Three HEDIS guideline changes.

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About HEDIS and Public Comment

HEDIS comprises measures of clinical quality and patient experience that are supported by the best scientific evidence about what works in health care. NCQA creates new HEDIS measures and updates or retires existing measures when new evidence becomes available in the scientific literature. NCQA convenes multi-stakeholder groups—including scientists, clinicians, consumers and purchasers—to ensure that the measures meet the high standards of relevance, scientific soundness and feasibility.

An important part of developing and updating HEDIS is the opportunity for the public to review measures and offer support, recommend changes or ask for clarification. NCQA reviews every message received during public comment, synthesizes themes and presents comments to the NCQA Committee on Performance Measurement for deliberation.

Neither NCQA nor HEDIS sets coverage or benefit policy.

Proposed New Measures

Depression Care for Adolescents and Adults:

NCQA proposes a set of three measures to assess care for depression for adolescents and adults:

1. Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults.
2. Depression Remission, Response or Treatment Adjustment for Adolescents and Adults.
3. Depression Screening and Follow-up for Adolescents and Adults.

The proposed measures address several significant quality concerns including under-diagnosis, under-treatment and lack of routine outcome monitoring among people with depression. To measure patient-reported outcomes for depression requires NCQA to imagine new methods of HEDIS reporting. As such, the depression measures would have a new reporting methodology to leverage electronic clinical data sources and a phased approach for implementation in HEDIS.

Risk Adjusted Utilization Measures

NCQA proposes two new risk adjusted utilization measures.

1. Inpatient Hospital Utilization: This measure will assess the number of acute medical and surgical inpatient discharges during the measurement year (observed) and the predicted probability of inpatient discharges (expected) for members 18 years of age and older. Age, gender and comorbid conditions are considered to calculate the expected number of inpatient discharges.
2. Emergency Department Utilization: This measure will assess the number of emergency department (ED) visits during the measurement year (observed) and the predicted probability of ED visits (expected) for members 18 years of age and older. Age, gender and comorbid conditions are considered to calculate the expected number of ED discharges.

Statin Therapy Measures

1. Statin Therapy for Patients With Cardiovascular Disease: NCQA proposes to assess the number of males 21–75 years of age and females 40–75 years of age with clinical atherosclerotic cardiovascular disease to improve the use and adherence of statin therapy for secondary prevention of cardiovascular disease. Two rates are reported for this measure: 1) Patients who were dispensed at least moderate intensity statin therapy at least once during the measurement year and 2) Patients who were dispensed at least moderate intensity statin therapy that they remained on for at least 80% of their treatment period. The proposed measure aligns with new blood cholesterol guidelines from the American College of Cardiology and American Heart Association (ACC/AHA).
2. Statin Therapy for Patients With Diabetes: NCQA proposes to assess the number of adults 40–75 with diabetes to improve the use and adherence of statin therapy for primary prevention of cardiovascular disease. Two rates are reported for this measure: 1) Patients who were dispensed any intensity statin therapy at least once during the measurement year and 2) Patients who were dispensed a statin of any intensity that they remained on for at least 80% of their treatment period. The proposed measure is based on recommendations from the ACC and AHA and the American Diabetes Association.

Hospitalization for Potentially Preventable Complications Measure: NCQA proposes to assess the number of hospitalizations among Medicare eligible adults for specific ambulatory care conditions that may have been prevented through appropriate outpatient care. The conditions are based on the National Quality Forum endorsed Prevention Quality Indicators, developed by Agency for Healthcare Research and Quality.

Proposed Changes to Existing Measures

Asthma Medication Ratio: This measure evaluates the effectiveness of managing asthma medication for people 5-64 years of age. Based on testing the implications of adding older adults to the asthma measures, NCQA proposes expanding the age range for commercial plans to include people 5-85 years of age and adding a Medicare product line for adults 18-85 years of age.

Medication Management for People With Asthma: This HEDIS asthma measure evaluates the effectiveness of managing asthma medication for people 5-64 years of age. NCQA proposes expanding the age range for commercial plans to include members 5-85 years of age and adding a Medicare product line for adults 18-85 years of age.

Medication Reconciliation Post-Discharge: This measure assesses the percentage of discharges from acute or non-acute inpatient facilities for adults 66 years of age and older for whom medications were reconciled within 30 days of discharge. NCQA proposes modifying the measure by expanding the eligible population to include adults 18 years and older for all Medicare plans, and by clarifying the hybrid specification by adding examples of medication reconciliation. These changes will help encourage care coordination for all Medicare enrollees who were discharged from an inpatient facility, as well as provide clarity on the type of documentation that counts as evidence of medication reconciliation.

Proposed Measure to Retire

Use of Appropriate Medications for People With Asthma: NCQA proposes retiring this measure because HEDIS performance rates have been consistently high for commercial and Medicaid plans over the past several years and the Medication Management for People With Asthma measure is a more effective way of assessing asthma medication management.

Guideline Updates

General Guideline 28: Members Who Switch Products: NCQA proposes to include PPO enrollment toward continuous enrollment for members who switch products within a given plan.

Guidelines for Relative Resource Use Measures: NCQA proposes four modifications to how NCQA: 1)calculates expected performance for health plans and 2) reports the Relative Resource Use measures. The modifications standardize the reporting of RRU with NCQA practices for other HEDIS measures, simplify interpretation of results and improve actionability. These changes will also accelerate the availability of the data to health plans and others who use the measures.

How to Participate in Public Comment

To read and comment on the proposed changes, visit http://www.ncqa.org/HomePage/NCQAPublicComments.aspx. The public comment period begins at 9 AM (ET) on February 18 and ends at 5 PM (ET) on March 18. NCQA will review input from public comment and will publish new and updated measures and guidelines in HEDIS 2016, Volume 2, in summer 2015.