Looking ahead: proposed measure changes for HEDIS® 2020

Looking for a breakdown of NCQA's changes for HEDIS Measurement Year 2022? Catch up on our most recent blog post here.

As part of its annual update process, the National Committee for Quality Assurance (NCQA) is accepting comments on proposed changes for next year’s HEDIS season from health plans and other stakeholders. Jamison Gillitzer, product manager for Cotiviti’s Quality and Performance solutions, offers a summary of the important details for plans that report HEDIS data.

What changes is NCQA proposing to existing measures for HEDIS 2020? 

NCQA’s proposed changes to existing measures would impact 13 measures next year. Among the most notable adjustments to hybrid measures are the following: 

  • Cervical Cancer Screening (CCS): Adding primary HPV testing every five years for women ages 30 to 64
  • Prenatal and Postpartum Care (PPC): Replacing the current postpartum care rate with three separate rates:
    • Early postpartum visit
    • Later postpartum visit
    • Early and later postpartum visit
  • Care for Older Adults (COA): Removing the fourth bullet (below) from the hybrid specification for the Functional Status Assessment indicator:
    • Notation that at least three of the following four components were assessed:
      • Cognitive status.
      • Ambulation status.
      • Hearing, vision and speech (i.e., sensory ability).
      • Other functional independence (e.g., exercise, ability to perform job).

What new measures are being introduced? 

NCQA is looking to add four new measures total related to substance abuse and pregnancy. 

Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)

This measure would track the percentage of acute inpatient hospitalizations, residential treatment, or detoxification visits for a diagnosis of substance use disorder (SUD) that result in a follow-up visit or service for substance use disorder among members 13 years of age and older. Two different rates would be reported. As noted by NCQA, “the intent of this proposed new measure is to assess timely follow-up and continued contact with the health care system following a high-intensity visit for a principal diagnosis of SUD.” 

Pharmacotherapy for Opioid Use Disorder (POD)

This measure would track the percentage of new opioid use disorder (OUD) pharmacotherapy episodes resulting in 180 or more covered treatment days among members 16 years and older with an OUD diagnosis. As NCQA explained, “literature suggests that pharmacotherapy can improve outcomes for individuals with OUD and that continuity of pharmacotherapy is critical to prevent relapse and overdose. However, despite the evidence and recommendations of clinical practice guidelines, pharmacotherapy is an underutilized treatment option for individuals with OUD.” 

Pre-natal Depression Screening and Follow-up (PND) and Post-partum Depression Screening and Follow-up (PPD)

These measures would track the percentage of deliveries in which women were screened for clinical depression during pregnancy and within 12 weeks of delivery, as well as the percentage of deliveries in which pregnant or postpartum women received follow-up care within 30 days of a positive screening. NCQA notes “the U.S. Preventive Services Task Force and other major guideline developers recommend screening all pregnant and postpartum women for depression and establishing and maintaining regular follow‐up for those diagnosed with depression.” 

Notably, these two pregnancy measures are specified for the HEDIS Electronic Clinical Data Systems (ECDS) reporting method, continuing NCQA’s efforts to promote the use of electronic clinical data such as electronic health records, health information exchanges, and case management systems.

Are any measures being retired?

Yes. NCQA proposes to retire the following measures: 

  • Ambulatory Care (AMB)
  • Inpatient Utilization (IPU)
  • Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART)
    • Commercial and Medicaid product lines only
  • Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC)
  • Osteoporosis Testing in Older Women (OTO)
    • Medicare Health Outcomes Survey (HOS) measure

In addition, NCQA is looking at removing four items from the CAHPS® survey: 

  • Shared Decision Making
  • Health Promotion and Education
  • Helpful Plan Information
  • Plan Information on Cost (commercial only)

We’ve discussed the measure-specific changes NCQA is proposing. What broader changes are being put forward? 

NCQA proposes to add digital measure format for 19 HEDIS measures, as well as voluntary ECDS reporting for three measures: 

  • Breast Cancer Screening (BCS)
  • Colorectal Cancer Screening (COL)
  • Follow-up Care for Children Prescribed ADHD Medication (ADD)

As NCQA explained, “stakeholders with whom we spoke supported this work and recommended NCQA focus this first year of expanded ECDS reporting on a few select measures of high importance to health plans and stakeholders, such as those widely used in programs, with different product lines and populations represented.” 

Additionally, as the use of telehealth tools such as smartphone and tablet apps continues to grow, NCQA is also proposing to include telehealth services within the following two measures: 

  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
  • Children and Adolescents’ Access to Primary Care Practitioners (CAP) 

However, noting that “limited evidence was found to support the use of telehealth for well-child visits,” NCQA is looking to prohibit the use of telehealth services in the following three measures: 

  • Well-Child Visits in the First 15 Months of Life (W15)
  • Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)
  • Adolescent Well-Care Visits (AWC)

How might health plans be impacted by implementing these changes? 

During this public comment period ending Monday, March 11, it’s important for health plans to have their voices heard, as they know best how these changes might impact their supported populations. 

As always, new measures will be in a “first year” status for HEDIS 2020. This means next year will essentially be a trial run, and the measures won’t be required for reporting. However, all new measures and measure changes likely come with changes to your vendor’s input specifications to capture new data elements. Plans will want to pay close attention to these changes when our input layouts are released in the fall to ensure they’re including all the necessary details to accurately report on these new and modified measures. 

A true strategic partner can help plans measure and report quality metrics confidently, efficiently, proactively, and repeatedly, transforming quality management into the core competency required for newly integrated, multifaceted quality measurement and reporting initiatives. Learn more about Cotiviti's Quality Intelligence from our fact sheet.

Read the fact sheet


HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).


Jamison Gillitzer
Jamison Gillitzer is a product director supporting Cotiviti’s Quality and Performance solution suite. His primary responsibilities are the successful delivery of our quality solutions to ensure they meet clients' needs in support of HEDIS, P4P, and other quality reporting initiatives. He also works to develop and enhance our capabilities to support evolving quality requirements. Jamison has a bachelor's degree in entrepreneurial management from the University of Minnesota and is PMC-III certified.

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