Retiring and Replacing HEDIS Measures, 2024-2026

July 17, 2023 · Andy Reynolds

We want to evolve HEDIS as the best performance measurement system for:

• Improving health equity.
• Supporting new models of care delivery.

With that goal in mind, we are revising HEDIS measures to:

• Better align with digital health data standards.
• Leverage electronic clinical data.
• Encourage standardized exchange of health information.

To enable this digital transformation, NCQA is replacing measures that are less relevant or outdated, or that can be revised to better address care issues at hand.

These changes will:

• Reduce health plans’ measurement burden.
• Free plans to implement new clinical data measures
• Help plans transition to digital quality operations.

Using feedback from public comment and our advisory panels, we have identified seven measures for retirement or replacement.

Retired for Measurement Year 2024

Narrowly scoped measures or no longer demonstrate opportunities for improvement:

• Ambulatory Care and Inpatient Utilization—General Hospital/Acute Care. Both measures are specified for the Medicaid population, but do not account for risk factors that impact utilization. Existing risk-adjusted measures provide a better signal of quality. We are exploring expanding these measures to include the Medicaid population.
• Non-Recommended Cervical Cancer Screening in Adolescent Females. This measure assesses females age 16–20 who were screened unnecessarily for cervical cancer. HEDIS performance data over the past few years indicate very little room for improvement.
• Use of Spirometry Testing in the Assessment and Diagnosis of COPD. This measure assesses whether adults age 40 and older had confirmatory spirometry testing for chronic obstructive pulmonary disease. This measure is not widely used and addresses only one aspect of COPD care (confirmation of a new diagnosis).

Retired for Measurement Years 2025 and 2026

Focus on available alternative measures and new measure development:

• Antidepressant Medication Management. This measure assesses whether adults with a diagnosis of major depression were newly treated with antidepressant medication and remained on their medications. This measure only addresses adherence to antidepressants as a treatment for depression and does not address other recommended treatments, such as psychotherapy. Other HEDIS measures address critical gaps in depression care, including screening, follow-up, routine monitoring and improvement in outcomes. We are working to expand these measures in reporting programs.When it’s happening: Measurement Year 2025.
• Pain Assessment Indicator—Care for Older Adults. The pain assessment indicator, specified for people age 65 and older who are enrolled in a Special Needs Plan or a Medicare-Medicaid Plan, assesses annual pain assessment. NCQA is developing a chronic pain measure focused on older adults that will incorporate important aspects of pain management: multidimensional assessment, which can provide a more holistic view of pain, function and psychosocial factors; and follow-up, which is an important aspect of pain management.When it’s happening: Measurement Year 2025.
• Medical Assistance with Smoking and Tobacco Related Cessation. This survey measure assesses whether current smokers were advised to quit and discussed cessation medication and strategies with their clinician. A new measure will expand to adolescents and will leverage electronic clinical data to incorporate prevention, screening and receipt of evidence-based cessation interventions. We plan to retire the survey measure when the replacement measure is ready, which is planned for HEDIS Measurement Year 2026.

The Big Picture: Help for Your Digital Transition

NCQA knows that organizations are at different levels of readiness to leverage clinical data.

That’s why we are committed to supporting organizations and providing resources as organizations adopt interoperability standards to leverage electronic clinical data for quality measurement and improvement.

The Resources and Publications section of our Electronic Clinical Data Systems page is a great place to start.