NCQA Is Developing a New HEDIS Measure for Colorectal Cancer Screening Follow-Up
March 17, 2025 · Becky Kolinski
NCQA is partnering with the Council of Medical Specialty Societies and the American Gastroenterological Association to develop a new HEDIS® measure to improve follow-up care for patients with abnormal colorectal cancer screening results. The project is funded by the Centers for Disease Control and Prevention.
Colorectal cancer represents approximately 8% of all new cancer cases; it is the third most commonly diagnosed cancer in the United States and the leading cause of cancer deaths in men under 50.1 Routine screening—through colonoscopy, stool-based testing or other methods—can detect precancerous polyps that can be removed before they develop into a later-stage cancer.
“Screening is important for all types of cancer, but it is especially critical for colorectal cancer because there’s a window of opportunity to prevent the cancer from developing,” says Alana Burke, Director of Health Equity Sciences at NCQA. “Providing timely follow up after an abnormal screening gives the patient a chance at a much better outcome.”
Why We Need a New Measure
There are five screening types, ranging from yearly stool-based tests to colonoscopies every 10 years. NCQA’s current HEDIS measure for colorectal cancer screening evaluates the percentage of people 45–75 who had appropriate screening for colorectal cancer. In MY 2023, colorectal cancer screening rates were 56% for commercial, 64% for Medicare and 39% for Medicaid.
While there’s a wealth of standards related to screening, national guidelines do not identify a time frame for completing a follow-up colonoscopy after an abnormal test—yet, timely follow up is critical: Patients who had an initial positive stool-based test, but did not have a follow-up colonoscopy, are twice as likely to die as those who had a follow-up colonoscopy.2
“Follow-up rates vary widely—from 24% to 75%. We need consensus on how quickly to follow up on abnormal test results,” says Tejal Patel, Senior Research Associate at NCQA. “We believe a HEDIS measure will standardize reporting and tracking of quality follow-up care and ultimately help save lives.”
Measure Development Process
The proposed measure will evaluate appropriate follow-up after an abnormal index screening result. NCQA measure development follows this process:
- Review evidence and convene experts to advise on measure development.
- Present the draft measure to NCQA advisory panels.
- Test the measure with health plans and health care delivery systems.
- Solicit feedback on the proposed measure through public comment.
NCQA Is Recruiting Organizations to Participate in Measure Testing
NCQA seeks health plans and health care delivery systems to test the availability and completeness of structured data from electronic clinical databases and to help us determine the feasibility of assessing colorectal cancer screening follow-up.
If your organization would like to participate in this testing effort, contact Alana Burke, Director, Health Equity Sciences.
Additional Resources
Download our white paper Improving Performance on Adherence to Follow-Up Colonoscopy.
Sources:
[1] National Cancer Institute, 2023.
[2] Zorzi, M., J. Battagello, K. Selby, G. Capodaglio, S. Baracco, S. Rizzato, E. Chinellato, S. Guzzinati, M. Rugge. March 2022. “Non-Compliance With Colonoscopy After a Positive Faecal Immunochemical Test Doubles the Risk of Dying From Colorectal Cancer.” Gut 71(3):561–7. doi: 10.1136/gutjnl-2020-322192. Epub 2021 Mar 31. PMID: 33789965; PMCID: PMC8862019.
The NCQA Healthcare Effectiveness Data and Information Set (HEDIS) Measures for Colorectal Cancer Screening project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award to the Council of Medical Specialty Societies (CMSS) totaling $1,563,853 with 100 percent funded by CDC/HHS. The contents are those of the authors and do not necessarily represent the official views of nor endorsement, by CDC/HHS or the U.S. Government.
