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As NCQA retires the Annual Dental Visit (ADV) measure, it is proposing to add two new HEDIS measures related to dental care: Oral Evaluation, Dental Services; and Topical Fluoride for Children. The organization notes that cavities are one of the most common chronic conditions in children in the U.S., and regular evaluations and topical fluoride applications are a preventative treatment for tooth decay. Both measures are adapted from existing Dental Quality Alliance (DQA) measures.
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Measure Name |
Summary of Proposed Details |
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Oral Evaluation, Dental Services (OED)
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The percentage of members under 21 years of age who received a comprehensive or periodic oral evaluation with a dental provider during the MY.
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Topical Fluoride for Children (TFC) |
The percentage of members 1–20 years old who received at least two topical fluoride applications during the MY.
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As NCQA increases its focus on social determinants of health (SDoH), another new proposed HEDIS measure (SNS-E) would screen members for unmet food, housing, and transportation needs and determine whether an intervention was performed for identified needs. Screenings would include:
This measure is part of a larger attempt by NCQA to improve health equity and increase accountability among health plans to evaluate and address social determinants of health for members. As NCQA notes, these needs have been identified as a priority by health plans, providers, and other health system entities, requiring a focus on measuring factors that go beyond typical clinical operations and outcomes. As there is no current national health plan measure to determine and address members’ social needs, NCQA states, the organization is prioritizing this measure to fill the existing gap.
Notably, the new proposed Social Needs measure would be reported using the using the HEDIS Electronic Clinical Data Systems (ECDS) reporting standard.
NCQA is proposing a measure that would address emergency department visits for hypoglycemia in diabetes patients 65 years and older.
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Measure Name |
Summary of Proposed Details |
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Emergency Department Visits for Hypoglycemia in Older Adults With Diabetes (EDH) |
For members 65 years and older with diabetes (types 1 and 2), the risk-adjusted ratio of observed-to-expected emergency department (ED) visits for hypoglycemia during the MY. |
As adult diabetics age, they become more prone to the negative effects of treatments meant to lower glucose, NCQA notes. They are also likelier to experience severe hypoglycemia, or low blood sugar, which leads to fall-related events and an increased risk of both cardiovascular events and cognitive decline. With the increased likelihood of these potentially damaging consequences, preventing hypoglycemia becomes key to aiding patient safety and avoiding intensive glycemic control. This is an opportunity for health plans to distinguish older diabetic patients with a high risk of hypoglycemia and implement fitting opportunities for prevention.
NCQA is updating the current HEDIS measure for Adult Immunization Status (AIS-E). The AIS-E measure evaluates the percentage of adults who are current on standard vaccinations, with separate indicators for influenza; tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap); zoster; and pneumococcal vaccinations. The proposed update will assess pneumococcal vaccination status while making new allowances and distinctions for member age-related factors and underlying conditions.
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Measure Name |
Summary of Proposed Changes |
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Adult Immunization Status (AIS-E) |
Pneumococcal numerator:
All numerators:
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This measure was initially included in MY 2022 specifications but was delayed to instead be released in MY 2023 due to the proposed changes. NCQA initially proposed an intermediate taper of ≥20% for members discontinuing the usage of benzodiazepines, due to concerns about the effects of withdrawal. But NCQA has conducted testing that suggests certain members can reach 100% discontinuation without an intermediate taper and without adverse effects.
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Measure Name |
Summary of Proposed Changes |
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Deprescribing of Benzodiazepines in Older Adults (DBO) |
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NCQA is looking to retire the Frequency of Selected Procedures (FSP) HEDIS measure, which recaps the usage of frequently performed procedures with high variation and highlighted potential for being over- and underutilized across clinical procedures. This measure was originally proposed in a prior public comment to be retired for MY 2022, but the retirement decision has been pushed to MY 2023. FSP includes procedures such as:
NCQA’s reasons for retiring this measure include:
NCQA is looking to make changes to AIS-E, including retiring three immunization measures reported with the CAHPS® Health Plan Survey method. Since AIS-E will be publicly reported in MY 2022, these proposed measure retirements are being suggested as part of an effort to streamline adult immunizations in HEDIS.
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Measure Name |
Summary of Proposed Measure Retirements within AIS-E |
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Adult Immunization Status (AIS-E) |
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NCQA introduced the race and ethnicity stratification to five HEDIS measures in MY 2022 and is looking to add at least five more measures in MY 2023. Based on feedback from expert panels and external stakeholders, the NCQA team developed a list of candidate measures for MY 2023 across several domains and is looking for feedback on this list as well as any others that should be considered.
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Domain |
Measure |
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Behavioral Health |
Follow-Up After Emergency Department Visits for Substance Use Disorder (FUA) |
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Pharmacotherapy for Opioid Use Disorder (POD) |
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Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) |
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Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E) |
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Prenatal Depression Screening and Follow-Up (PND-E) |
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Postpartum Depression Screening and Follow-Up (PDS-E) |
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Prevention and Screening |
Breast Cancer Screening (BCS-E) |
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Adult Immunization Status (AIS-E) |
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Immunizations for Adolescents (IMA, IMA-E) |
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Prenatal Immunization Status (PRS-E) |
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Utilization |
Well-Child Visits in the First 30 Months of Life (W30) |
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Access and Availability of Care |
Initiation and Engagement of Substance Use Disorder Treatment (IET) |
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Respiratory |
Asthma Medication Ratio (AMR) |
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Care Coordination |
Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC) |
NCQA is looking for public comments on these new proposed HEDIS measures, updates to existing measures, proposed measure retirements, and new topics by 5:00 pm ET, Friday, March 11. Submit your comments via the NCQA public comment website.
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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).