Future of HEDIS Webinar: Pandemic Results, Health Equity and Digital, Digital, Digital

October 20, 2021 · Andy Reynolds

The September 30 installment of NCQA’s best-attended webinar series, The Future of HEDIS, illuminated four new areas of knowledge for the growing universe of HEDIS users.

(To get slides and a recording of the event, see The Future of HEDIS and scroll to Webinar Archives, Episode 10: HEDIS During and After the Pandemic.)

NCQA founder and president Peggy O’Kane assessed the state of quality measurement and outlined why it’s important to update HEDIS. Then leaders from different parts of NCQA debuted new information for the 1,100 webinar viewers watching in real time.

1) Measurement Year 2020 Results

NCQA Assistant Vice President for Performance Measurement Sarah Shih presented the first public look at health plans’ HEDIS results for Measurement Year 2020.

Results were better than many people feared they would be during the pandemic. Some measures had statistically significant declines in performance. Performance for other measures improved. On balance, MY 2020 results show the industry adapted and met the COVID challenge remarkably well.

See slides 4-14 of the presentation and 9:50-18:50 of the webinar recording for Sarah’s recap of HEDIS results.

2) Equity as a Permanent Pillar of HEDIS

After explaining what happened with HEDIS results last year, Sarah outlined how health equity is a thread or theme in all NCQA programs.

Two ideas animate this infusion of health equity into everything we do:

• High quality care is equitable care.
• There can be no quality without

To highlight what an equity emphasis means for HEDIS, Sarah shared the three main parts of NCQA’s health equity strategy:

• Investigate: This first step means defining equitable care. It includes identifying data, building measurement techniques and making measures that can identify disparities.(Our recent work to stratify HEDIS measures by race and ethnicity is part of the Investigate agenda. Stratifying measures was a focus of Future of HEDIS Episodes 8-9, and our October 13 Quality Innovation Series session.)

• Illuminate: Our middle step includes finding examples of organizations that are eliminating disparities. We seek these examples so we can reveal things other organizations can do to become more equitable.
• Elevate: Our third step explores how to pay for equitable care. This includes helping policymakers and payers incent, scale and sustain ways to eliminate disparities.

Consult slides 15-28 and webinar recording 19:00-28:45 to see the discussion of health equity.

3) What’s New & What’s Next in Digital Measures

Assistant Vice President for Performance Measurement Anne Smith’s big news was the September 10 release of 22 new FHIR/CQL digital measures.

Being digital means these measures save HEDIS users the trouble of having to read, interpret and reprogram measures into their own information systems. We write digital measures as computer code so you don’t have to.

Anne also explained where we are in the overall plan to introduce digital measures and the challenges that remain.

Read about digital measures on Anne’s slides 29-34 and at 28:35-35:50 in the webinar recording.

4) Digital Solutions: Building Beyond Health Plan Reporting

Chief Product Officer Dr. Brad Ryan rounded out the webinar by explaining how digital thinking can expand quality measurement beyond traditional uses of HEDIS.

Brad presented a layered, step-wise WHY-WHAT-HOW vision. The best way to absorb that vision is to read slides 35-49 and  watch 36:00-55:25 of the recording. That way, you can hear how the ideas build and relate.

The short version is:

• The purpose of NCQA’s digital strategy is to measure what matters and reward better care.
• The trust and ubiquity of HEDIS make HEDIS a strong foundation on which to build diverse digital solutions that can do things traditional HEDIS isn’t designed to do.
• Digital thinking pervades the effort to update HEDIS. Digital applies to measurement content—that is, what and how to measure. An example is using remote home monitoring to track A1c levels of people with diabetes.Digital also applies to measurement delivery—how users ingest, implement and interact with measures. The 22 new digital measures Anne talked about earlier in the webinar as nascent examples of what digital delivery could ultimately mean.

We are careful that our digital vision fits CMS’ goal of all-digital measurement by 2025.

In all, the webinar’s 19-minute digital discussion points to transformational changes. Again, we recommend reading slides 35-49 and watching 36:00-55:25 of the recording.

Overtime Questions from Episode 10

Peggy, Sarah, Anne and Brad didn’t get through all the questions viewers submitted during the webinar.

We address leftover questions below and have directed the people who asked them to this page.

Q1: What member demographics are required for the health equity measures? (Race, ethnicity, sexual orientation, gender identity, disability status, Veteran status, socioeconomic status, etc.?
A1: Currently: Race, ethnicity. We’ve begun discussions on including other domains such as geography, gender, sexual orientation, primary language.

Q2: For equitable care, how specific will NCQA be defining race/ethnicity categories? Will it align with CDC’s categories for race/ethnicity?
A2: NCQA will align with the OMB race/ethnicity categories, including options of Asked but No Answer and Unknown (missing).

Q3: What else can you share about the California initiative a speaker mentioned that improves the rate of direct, member-submitted race/ethnicity data
A3: We recommend two resources
First, Covered California Holding Health Plans Accountable for Quality and Delivery System Reform (page 12).
Second, this Manatt report: Unlocking Race and Ethnicity Data to Promote Health Equity in California

Q4: Is there a place to review the evidence-based scholarly resources used to support the choosing of each measure?
A4: NCQA includes the evidence-based studies for existing measures in HEDIS Volume 1. Additionally, the memo and measure workup in the public comment process provide a studies and other references/resources.

Q5: Electronic Clinical Quality Measures (eCQMs) are a common set of measures used in provider reporting. With the shift you talked about toward more provider reporting on HEDIS measures, what do you see as the future of these measures sets, recognizing the industry emphasis on consolidation and standardization of quality measures?
A5: HEDIS reporting is at the health plan level. The emphasis will be on sharing data between providers and payers to get a complete picture of each patient. We would like to see alignment of measures across levels of the health care system and data sharing between providers and payers. That way, regardless of who is reporting on a patient, all organizations have the correct status for that patient.

Q6: I would like to know about the Breast Cancer Screening (BCS) measure, as women are being told that COVID vaccine can affect lymph nodes. I had to have a negative mammogram before I could be administered the vaccine. Some women are putting off their mammograms to be able to receive vaccine.
A6: While we agree this may be an individual concern in scheduling a mammogram, the COVID impact on lymph nodes is temporary and the measure and guideline allow for 27 months to receive a mammogram. Thus, it is unlikely additional grace period is needed.

Q7: Has there been consideration on Rural/Frontier geographic locations with respect to digitization? I would imagine there are “digital deserts” and if we’re going to address health equity, this is needs to be considered.
A7: NCQA recognizes there may be “digital deserts” either by geography or neighborhood divestment. As information on care access is not detailed in measurement, care organizations and health systems will need to consider how to deliver care and assess access through telehealth for their settings and populations.

Q8: We noted a drop in the flu vaccine rates for our plan. The 2021 CAHPS survey refers to 2020 flu vaccine data. Are there plans for NCQA/CMS not to include this measure for the quality withhold calculation since flu vaccine compliance rate was also affected by the pandemic in 2020?
A8: Flu remains a risk during the winter in COVID and can increase risk for COVID patients. While we agree there may be regional reductions in flu shots, we are also seeing regions where flu shots have increased. Many of our measurement partners are interested in the true performance by organizations and have continued to use measures during COVID. This remains an organization/regulatory decision. We suggest you work with CMS directly about this concern.

Q9: Timing of mammograms after vaccinations is very confusing to patients. Different lengths of time are all over the media. I’ve seen 4 weeks to 3 months. Care to comment?
A9: NCQA continues to use the US Preventive Services Task Force Guidelines as the basis for the Breast Cancer Screening measure. The current measure allows up to 27 months to receive a mammogram. We are not a clinical or guideline organization and thus, it is outside of our scope to provide medical advice. In terms of the measure, we will continue to look for alignment with the USPSTF.

Q10: I love this stuff and really appreciate the work you do! Might it be possible to have plans segment their data universe by ethnicity?
A10: NCQA created the Allowable Adjustments for HEDIS measures as guidance for organizations who would like to modify the measure while maintaining the clinical intent. Many of the measures Allowable Adjustments include the ability to stratify reporting for race/ethnicity, social determinants of health, or other demographic data. Note that Allowable Adjustments are for internal QI purposes only and are not for HEDIS health plan reporting.

Q11: Based on the declines seen in measures affected by access to care such as Comprehensive Diabetes Care (CDC) and Controlling High Blood Pressure (CBP), why didn’t NCQA’s Quality Compass benchmarks reflect these declines for the commercial PPO line of business?
A11: We would need to see the benchmarks being referenced to provide an answer. Benchmarks are provided for national, state or regional or specific reporting product breakout.

Q12: The presentation shows how rates have dropped for some of the measures, but we have also seen the Quality Compass benchmarks go up for those measures. Can you shed some light on that?
A12: We would need to see the benchmarks you mean to provide an answer. Benchmarks are provided for national, regional and state levels, or for specific product lines.

Q13: Have you decided on Utilization Measures for 2022 Health Plan Ratings?
A13: The Risk Adjustment Utilization (RAU) measures are slated to be used in the 2022 Health Plan Ratings. Earlier this year, we posted the 2022 HPR Measure List here: https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2022/. We will continue to assess the impact of the pandemic to determine if changes are needed.

Q14: When are benchmarks going to be released?
A14: Quality Compass 2021 (MY 2020) benchmarks have been released for Commercial and Medicaid product lines. They are available through the NCQA Store (https://store.ncqa.org/). Or contact informationproducts@ncqa.org.

Q15: Do you have results for the CWP Appropriate Testing for Children With Pharyngitis (CWP) measure
A15: Yes, in Quality Compass. For Appropriate Testing for Pharyngitis (Total), National Average, All Lines of Business, the rate decreased from 75.36% in 2019 to 72.30 in 2020. We saw larger decreases in age groups 18-64 and 65+ years.

Q16: Will NCQA ever produce Marketplace benchmarks
A16: Maybe. Quality Compass Exchange is on our product roadmap as a potential product offering to investigate in late 2021 or 2022.

Q17: Is there a decision to report the ECDS measures publicly?
A17: Quality Compass MY 2020 benchmarks were already released for the Commercial and Medicaid product lines. Medicare benchmarks will be released on October 29th. Anyone interested in buying full Quality Compass access (benchmarks and individual plan results) can get them from the NCQA Store (https://store.ncqa.org/). Contact informationproducts@ncqa.org for custom data sets or other help.