Accrediting group updates widely used quality metrics

Dive Brief:

The National Committee for Quality Assurance is seeking feedback from health plans, purchasers and other stakeholders on changes to its Healthcare Effectiveness Data and Information Set (HEDIS) measures.

The proposed update includes new HEDIS measures assessing substance abuse disorder and prenatal and postpartum depression care, as well as revisions to existing measures and those that apply across multiple measures.

NCQA is also proposing to retire five measures and shorten the HEDIS Health Plan Consumer Assessment of Health Providers and Systems Survey.

Dive Insight:

NCQA contracts with CMS, and Medicare Advantage plans use HEDIS measures to assess performance within their provider networks. With growing MA participation — 22.4 million people enrolled for 2019 coverage, up 6.8% from a year ago — and more focus on quality metrics across healthcare generally, any changes to HEDIS will be closely watched.

The new measures and changes reflect a growing appreciation of the importance of behavioral health and preventive care. In addition to substance abuse disorder and prenatal and postnatal care, NCQA is proposing a new measure to evaluate pharmacotherapy for opioid use disorder.

Changes are also being proposed for a number of current measures — among them, adherence to antipsychotic medications for people with schizophrenia and use of opioids at high dosage.

Several updates target care of older adults. One would reduce the number of options for satisfying functional status assessment, while encouraging standardization in documentation. Another seeks to align two measures assessing inappropriate use of medications with recent recommendations.

The update would also expand the age ranges and product lines for several measures aimed at curbing inappropriate use of antibiotics. And it would add high-risk human papillomavirus testing as a primary screening option for cervical cancer.

NCQA also proposes including telehealth in certain HEDIS physical health measures and increasing use of digital formats to increase clinical data exchange. Specifically, the group calls for gradually adding digital formats to HEDIS measures and adding the Electronic Clinical Data Systems reporting standard to measures on breast cancer screening, colorectal screening and follow-up care for children prescribed ADHD medication for purposes of voluntary reporting on top of traditional methods.

Proposed for retirement are five measures assessing ambulatory care, inpatient utilization of general hospital acute care and services, disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis, osteoporosis testing in older women and use of multiple concurrent antipsychotics in children and adolescents.

NCQA points to evidence and validity concerns in dropping the anti-rheumatics and osteoporosis measure. The group said use of multiple concurrent antipsychotics in children measure is "extremely low, with little variability in performance demonstrated across plans."

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