Changes to all NCQA programs resulting from the pandemic are summarized here.
Updated June 5, 2020
The Board of Directors of the National Committee for Quality Assurance (NCQA) approved a sweeping set of adjustments to 40 of its widely-used Healthcare Effectiveness Data and Information Set (HEDIS) measures – in support of health plans, clinicians and patients who rely on telehealth services in record numbers as a result of the disruption brought on by the COVID-19 pandemic.
The changes will apply to the measurement of health care quality starting this year. They align with recent telehealth guidance from the Centers for Medicare & Medicaid Services and other federal and state regulators.
“You cannot drive quality improvement if your measures don’t take into account what has quickly become the fastest growing modality for providing health care services,” said NCQA President Margaret E. O’Kane. “The timely approval by our Board of these changes signals that we understand the important role telehealth has played in making care available amid an unprecedented national lockdown and that it will continue to be an important part of the health care system going forward.”
40 HEDIS Measures With New Telehealth Accommodations
Prevention and Screening
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
- Breast Cancer Screening
- Colorectal Cancer Screening
- Care for Older Adults
Respiratory
- Use of Spirometry Testing in the Assessment and Diagnosis of COPD
- Asthma Medication Ratio
Cardiovascular Conditions
- Controlling High Blood Pressure
- Persistence of Beta-Blocker Treatment After a Heart Attack
- Statin Therapy for Patients with Cardiovascular Disease
- NEW MEASURE: Cardiac Rehabilitation
Diabetes
- Comprehensive Diabetes Care
- NEW MEASURE: Kidney Health Evaluation for Patients with Diabetes
- Statin Therapy for Patients with Diabetes
Musculoskeletal Conditions
- Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis- Scheduled for Retirement
- Osteoporosis Management in Women Who Had a Fracture
- NEW MEASURE: Osteoporosis Screening in Older Women
Behavioral Health
- Antidepressant Medication Management
- Follow-up Care for Children Prescribed ADHD Medication
- Follow-up After Hospitalization for Mental Illness
- Follow-up After Emergency Department Visit for Mental Illness
- Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication
- Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
- Diabetes Monitoring for People with Diabetes and Schizophrenia
- Adherence to Antipsychotic Medications for Individuals with Schizophrenia
Care Coordination
- Transitions of Care
- Follow-up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions
Access/Availability of Care
- Prenatal and Postpartum Care
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
Utilization
- Well-Child Visits in the First 30 Months of Life
- Child and Adolescent Well Care Visits
- Mental Health Utilization
Risk-Adjusted Utilization
- Plan All-Cause Readmissions
- Hospitalization Following Discharge from a Skilled Nursing Facility
- Acute Hospital Utilization
- Emergency Department Utilization
- Hospitalization for Potentially Preventable Complications
Measures Reported Using Electronic Clinical Data Systems
- Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
- Depression Screening and Follow-up for Adolescents and Adults
- Postpartum Depression Screening and Follow-up
- Prenatal Depression Screening and Follow-up
- Breast Cancer Screening
- Colorectal Cancer Screening
- Follow-up Care for Children Prescribed ADHD Medication
Updates to these 40 measures will be reflected in HEDIS Volume 2 Technical Specifications, to be published on July 1, 2020. Telehealth revisions will be outlined in each measure specification’s “Summary of Changes” section.
NCQA will continue to evolve HEDIS and other products to reflect and reinforce new technology.
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