Breaking down NCQA’s proposed changes for HEDIS Measurement Year 2020

Well-Child Visits in the First 15 Months of Life (W15)

• Remove hybrid reporting as medical record review has had a lower impact on performance over time
• Add 15–30 months age range to incorporate children previously not captured
• Remove performance rates for 0–5 visits and provider type requirement
• Rename to Well-Child Visits in the First 30 Months of Life

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)

Adolescent Well-Care Visits (AWC)

• Combine the two measures and rename to Child and Adolescent Well-Care Visits
• Remove hybrid reporting
• Add 7–11 year age range and split adolescent age range into two age groups

Emergency Department Utilization (EDU)

• Remove ED visits that convert to observation stays from the numerator to bring measure into alignment with other risk-adjusted utilization measures
• Classify members who utilize ED with high frequency as outliers and remove them from risk-adjusted ED rate
• Add a new indicator reporting the rate of outliers among the plan population to promote transparency in reporting members who are excluded due to outlier status

Use of High-Risk Medications in Older Adults (DAE)

• Add new measure rate to include antipsychotics and benzodiazepines and their corresponding diagnosis-based exclusions
• Remove 90-days supply criterion for non-benzodiazepine hypnotics to alleviate concerns of unintended consequences of prescribing benzodiazepines in place of them
• Extend continuous enrollment from one to two years to build in a look-back period
• Change assessment of numerator compliance from specific medications to medication class
• Add a total rate to provide a high-level overview of high-risk medication use

Transitions of Care (TRC)

• Revise “one medical record” requirement to also allow “other information accessible” to the PCP or care provider (e.g., shared EMRs)

Controlling High Blood Pressure (CBP)

• Restructure the denominator to allow a minimum of six months for interventions to help control a member’s blood pressure during the measurement year

Follow-Up After Hospitalization for Mental Illness (FUH)

• Allow follow-up visits in behavioral healthcare settings to count in the numerator without requiring a specific provider type
• Allow community mental health centers (CMHC) and certified community behavioral health clinics (CCBHC) to meet the HEDIS definition of “mental health providers”

Adult Immunization Status (AIS)

• Remove numerator requirements for pneumococcal immunization status to reflect that pneumococcal conjugate vaccine (PCV13) is no longer routinely recommended for adults 65 and older

Unhealthy Alcohol Use Screening and Follow-Up (ASF)

• Revise exclusion timing to only exclude members who have an alcohol use disorder (AUD) diagnosis in the prior year, not the measurement year

Depression Screening and Follow-Up for Adolescents and Adults (DSF)

Prenatal Depression Screening and Follow-Up (PND)

Postpartum Depression Screening and Follow-Up (PDS)

• Raise threshold for identifying members who screen positive for depression to help target resources to those in most need of follow-up care

Cardiac Rehabilitation (CRE)

“The percentage of members 18 years and older who attended cardiac rehabilitation following a qualifying cardiac event, including myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, heart and heart/lung transplantation or heart valve repair/replacement.”

This includes three rates:

• Initiation: % of members who attended two more rehabilitation sessions following a qualifying event
• Engagement: % of members who attended 12 or more rehabilitation sessions within 90 days of a qualifying event
• Achievement: % of members who attended 36 or more sessions within 180 days of a qualifying event

Kidney Health Evaluation for Patients with Diabetes (KED)

“The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year.” Replaces Comprehensive Diabetes Care (CDC)–Medical Attention for Nephropathy.

Osteoporosis Screening in Older Women (OSW)

“The percentage of women 65–75 years of age who are screened for osteoporosis.” Replaces Osteoporosis Testing in Older Women (OTO).

Annual Dental Visit (ADV)

• Sets a low threshold and focuses on access to dental care versus quality

Adult BMI Assessment (ABA)

• Less relevant as automatic calculation of BMI in EHR systems is standard practice
• Changes to ICD-10 coding guidelines
• Average Medicare performance has nearly topped out

Medication Management for People with Asthma (MMA)

• New recommendations for controller combination therapy
• Recent evidence suggesting measure not coordinated with improved outcomes

Children and Adolescents’ Access to Primary Care Practitioners (CAP)

• Proposed revisions to current well-child measures make this obsolete

Comprehensive Diabetes Care (CDC)–Medical Attention for Nephropathy indicator

• Feedback that this indicator is not precise enough to meet the needs of kidney health evaluation as an aspect of diabetes management
• Replaced by proposed KED measure

Comprehensive Diabetes Care (CDC)–HbA1c Control (<7.0%) for a Selected Population indicator

• Concerns about large burden on plans reporting CDC measure outweigh benefit of indicator
• Other indicators already meet intent for quality measurement of HbA1c testing and control

Volume 1 (Narrative) and Volume 2 (Technical Specifications)

July 1, 2020

July 1, 2020 (combined with MY 2020)

August 1, 2021

Volume 2 Technical Update

October 1, 2020

March 31, 2021

March 31, 2022

Vendor Certification

February 15, 2021

October 1, 2021

July 1, 2022