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HEDIS® During and After the Pandemic September 30, 2021
Margaret E. O’Kane, PresidentSarah Shih, MPH, Assistant Vice President, Research & AnalysisAnne Smith, Assistant Vice President, Performance MeasurementBrad Ryan, MD, Chief Product Officer
Agenda
THE BIG PICTURE
HEDIS RESULTS: MEASUREMENT YEAR 2020
HEALTH EQUITY: A PILLAR OF HEDIS
DIGITAL MEASURES: MEASUREMENT YEAR 2022
DIGITAL SOLUTIONS: BUILDING BEYOND
HEALTH PLAN QUALITY REPORTING
The Big
Picture
by Peggy O’Kane
HEDIS results amid COVID in 2020
4
What happened to health plans’ performance in measurement years 2018-2020?
Small shifts in performance
• Some decreases (expected)
• Some increases (surprising)
• Need for continued monitoring
Adaptation
• Acceleration and Emergence of
Virtual or Remote Care
• Policy Changes to Payment
• Reduced Capacity for Social Distancing
NCQA responded early to COVID
Updated telehealth guidance
• 40 HEDIS measures for MY 2020, 2021
(ncqa.org/covid/#hedistelehealth)
Special policy for Health Plan Ratings
• Plans compared to current year benchmarks
• “Better of’ 2020 or 2021 overall rating
5
The World Health Organization declared COVID-19 a pandemic on 3/11/20.
6
Controlling High Blood Pressure (CBP) got worse
54.758.9
69.5
56.2
60.8
49.5*
56.0*
62.7*
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Commercial Medicaid Medicare
% w
ith H
ypert
ensio
n w
ith B
lood P
ressure
<140/9
0
2018 2019 2020
-6.7-3.8
-6.8
*Statistically significant
7
Breast Cancer Screening (BCS) got worse
72.0
58.4
73.472.9
58.4
70.5*
53.7*
70.0*
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Commercial Medicaid Medicare
% R
eceiv
ed
Ma
mm
og
rap
hy
2018 2019 2020
-2.3
-4.7
-3.4
*Statistically significant
8
Statin Therapy for Patients with Cardiovascular Disease (SPC) – Adherence improved
76.3
64.6
80.677.8*
67.8*
79.9*
71.6*
85.5*
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Commercial Medicaid Medicare
%w
ith S
tatin A
dhere
nce
2018 2019 2020
*Statistically significant
2.1
4.9
3.8
9
Follow-Up After Hospitalization for Mental Illness (FUH) improved
Note: Follow-up After 7-days
44.2
35.8
27.6
45.0
36.4
49.7*
39.6
30.6*
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Commercial Medicaid Medicare
% F
ollo
w-u
p A
fter
7 d
ays
2018 2019 2020
4.7
3.2
3.0
*Statistically significant
10
Childhood Immunization Status (CIS) no change
Note: CIS Combo 10 includes all recommended childhood immunizations. This measure has a 2-year look back period.
52.3
35.2
54.4
38.2
55.2
38.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Commercial Medicaid
% w
ith C
hild
hood I
mm
uniz
ations
2018 2019 2020
*Statistically significant
0.8
0.7
11
Flu Vaccinations for Adults (FVA) widening gap
52.4
41.8
55.4*
43.8*
57.0
40.0*
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Commercial Medicaid
% w
ith F
lu V
accin
ations
2018 2019 2020
1.6
-3.8
*Statistically significant
Note: Data Source is from CAHPS survey
12
Future of HEDISWhat’s next?
• Continue to monitor closely – Will there be delayed performance changes?
• Potential deeper dive – How has health care adapted with virtual or remote care?
• Identifying Disparities – Can we detect unwarranted differences?
• Share your stories and findings
The future and our focus on health equity
1414
FLEXIBILITYAllowable
Adjustments
ACCURACYLicensing &
Certification
EASEDigital Measures
ACCESSTelehealth
The Future
of HEDIS
See our Future of HEDIS
webinar series:
https://www.ncqa.org/
hedis/the-future-of-hedis/
6 themes
INSIGHTECDS Reporting
EQUITYClosing
Care Gaps
FLEXIBILITYAllowable
Adjustments
The Future
of HEDIS
6 themesAllowable Adjustments
To give you flexibility in
how you use our measures,
we'll tell you their
allowable adjustments.
15
The Future
of HEDIS
6 themesLicensing & Certification
We’ll make sure uses of our
measures are accurate and
reflect quality of care.
ACCURACYLicensing &
Certification
16
The Future
of HEDIS
6 themesDigital Measures
We’ll give you measures in a digital
format that’s easier to work with.
EASEDigital Measures
17
The Future
of HEDIS
6 themesElectronic Clinical Data Systems (ECDS) Reporting
A new reporting method
helps clinical data create
insight.
18
INSIGHTECDS Reporting
The Future
of HEDIS
6 themes
ACCESSTelehealth
Telehealth
Align. Adapt. Innovate.
See recommendations of our
Taskforce on Telehealth Policy:
ncqa.org/telehealth
19
The Future
of HEDIS
6 themesEquity
Closing care gaps to make
care equitable makes
care better.
20
EQUITYClosing
Care Gaps
EQUITYprinciples
that drive us
High quality care is
equitable care
No quality without
equity
Build equity into all
NCQA programs
EQUITYClosing Care Gaps
21
What problems can we help resolve together?Envisioning solutions
Defining
Equitable
Care
Becoming
Equitable
Care
Paying for
Equitable
Care
INVESTIGATE ILLUMINATE ELEVATE
EQUITYClosing Care Gaps
22
Measures with Race and Ethnicity Stratification
Measure Product Lines Domain
Colorectal Cancer Screening (COL; COL-E)Commercial,
Medicare
Effectiveness of
CareControlling High Blood Pressure (CBP)Commercial,
Medicaid, Medicare
Hemoglobin A1c Control for Patients With
Diabetes (HBD)
Commercial,
Medicaid, Medicare
Prenatal and Postpartum Care (PPC)Commercial,
Medicaid
Access & Availability
of Care
Child and Adolescent Well Care Visits (WCV)Commercial,
MedicaidUtilization
Measures selected for MY2022 stratification
23
EQUITYClosing Care Gaps
Timeline for expanding stratificationPath forward
24
✓ Provides bridge from where we are to where we want to be
✓ Gives plans time to improve direct data collection
≥15 measures total
MY 2022 MY 2023 MY 2024
All plans: 80% direct
(potential indirect supplement)
Plans use direct data to degree available
(supplement with indirect as needed)
5 measures total ≥10 measures total
First year
analysis of data
EQUITYClosing Care Gaps
25
Health Equity Accreditation: Coming October 5
Organizational Readiness
and Promoting DEI
Race/Ethnicity, Gender Identity,
Sexual Orientation and
Language Data Collection
Access and Availability of
Language Services
Practitioner Network
Responsiveness
Cultural and Linguistically
Appropriate Services Programs
Reducing Health Care
Disparities(report stratified HEDIS measures)
Scoring aligns with Health Plan Accreditation. Look for an announcement email next week. EQUITYClosing Care Gaps
26
Want more details on HEDIS and equity?
Registration:
ncqa.org/qiseries
EQUITYClosing Care Gaps
What’s new and what’s next with digital measures
28
Our vision for quality measurement
Measures that support QI at multiple levels of the system
Meaningful, patient-centric measurement strategies
Expanded use ofelectronic data
BETTER
VALUE
Expanded
data access,
improved
content
and flow
Programs
use better
measures
Measures
move beyond
visit counts
and low-bar
process
Using technology to improve
information available for
measurement
EASEDigital Solutions
The digital quality ecosystemDigital Quality Measures are the foundation
Foster patient-specific care
Leverage more and better data
into greater insight
Align with interoperability and
value-based payment models
29
Decrease measurement
burden
EASEDigital Solutions
NCQA’s Digital Quality Measure (dQM) work
30
HEDIS MY 2022
• Released 22 dQMs using FHIR/CQL
• Measures can be purchased
individually
• Tested subset of measures against
Measure Certification test decks
2020 2021
HEDIS MY2020/2021
• Released 19 dQMs using Quality Data
Model (QDM)/Clinical Quality
Language (CQL)
• Measures purchased in two bundles
Draft FHIR dQMs
• Released 5 draft dQMs using Fast Health
Interoperability Resources (FHIR)/CQL
EASEDigital Solutions
Digital measure packages for HEDIS MY 2022 released September 10!
Highlights and challenges
Highlights
Measures are in FHIR/CQL
New data elements
Common logic organized into
libraries
Measure packages include
value sets JSON files
Challenges
Adjusting to new data model
Learning curve for new
resources (e.g., claims)
Understanding complicated
logic/less human readable
Pace for digitalization of
measures
32
EASEDigital Solutions
Digital Solutions: Building beyond health plan quality reporting
34
WHY
WHAT
HOW
DIGITAL SOLUTIONS
HEDIS
TRUSTUbiquitousValidated Comparable Consensus-driven Evidence-based
191,000,000 covered lives
Billion$ in value-based payments
HEDIS is a strong foundationfor digital solutions
35
Why evolve HEDIS? Why digital quality? WHY
MEASURE WHAT MATTERS,
REWARD BETTER CARE
WHAT:
3 PARTS
36
What does digital enable? WHAT
37
Expanding what HEDIS enables WHAT
GOALS FUNCTIONSLEVELS
38
WHAT
GOALS FUNCTIONSLEVELS
What you measure and
reward to get more of
Synonyms:
Priority, Area of Focus,
Strategic Center
Examples:
Broad: Improve health equity,
reduce measurement burden
Narrow: Control blood sugar
of teens who have diabetes
Expanding what HEDIS enablesSupporting priority populations and topics
PAYER
39
WHAT
GOALS LEVELS
PROVIDER
PURCHASER
CONSISTENTMeasures work similarly between levels
Reporting
Contracting
ContractingReporting
CONNECTEDMeasure calculations roll up to the next level
FUNCTIONS
Expanding what HEDIS enablesSo you can find and reward quality at all LEVELS OF THE SYSTEM
40
WHAT
GOALS FUNCTIONSLEVELS
PAYMENTREPORTING
“Dear Partner
Org: Here are
the results we
can both trust.”
Expanding what HEDIS enablesSo you can use it for FUNCTIONS other than reporting health plan quality
41
WHAT
GOALS FUNCTIONSLEVELS
PAYMENTREPORTING
“Dear Partner
Org: Here are
the results we
can both trust."
MEASUREMENT
“I just want to
understand and
use a measure.”
Expanding what HEDIS enablesSo you can use it for FUNCTIONS other than reporting health plan quality
42
WHAT
GOALS FUNCTIONSLEVELS
PAYMENTREPORTING
“Dear Partner
Org: Here are
the results we
can both trust.”
MEASUREMENT
“I just want to
understand and
use a measure.”
MANAGEMENT
“How’m I doing?
...And why?”
Expanding what HEDIS enablesSo you can use it for FUNCTIONS other than reporting health plan quality
43
WHAT
GOALS FUNCTIONSLEVELS
PAYMENTREPORTING
“Dear Partner
Org: Here are
the results we
can both trust."
MEASUREMENT
“I just want to
understand and
use a measure.”
MANAGEMENT
“How’m I doing?
...And why?"
IMPROVEMENT
“How can we
get better?”
Expanding what HEDIS enablesSo you can use it for FUNCTIONS other than reporting health plan quality
44
WHAT
GOALS FUNCTIONSLEVELS
PAYMENTMEASUREMENT
“I just want to
understand and
use a measure.”
MANAGEMENT
“How’m I doing?
...And why?”
OPTIMIZATION
“How can I make
the most of my
improvement
efforts?”
IMPROVEMENT
“How can we
get better?”
REPORTING
“Dear Partner
Org: Here are
the results we
can both trust."
“What's the
financial impact
of my quality
performance?”
Expanding what HEDIS enablesSo you can use it for FUNCTIONS other than reporting health plan quality
45
DIGITAL:
2 PARTS
HOW
Here’s more on how digital works
46
What and how to measure How you ingest, implement and interact
with measures and content
HOW
Digital
CONTENTDigital
DELIVERY
New and different measures based on
new and different data sources
Example:
FHIR/CQL measures that are
configurable and API-enabled
Example:
Tracking diabetes control through home
monitoring
Eventually:
Digital measures as software
components (think: Spotify!)
Here’s more on how digital works
47
WHY
WHAT
HOW
Measure What
Matters
Reward Better Care
Meet
diverse
GOALS
Digital
DELIVERY
Measure @
different
LEVELS
Enable more
measurement
FUNCTIONS
Digital
CONTENT
Bringing it all together...
Questions
49
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My Questions
Ask a Question
Submit Your Question
PCSPolicy Program
Clarification Support
my.ncqa.org
How to ask questions after today’s Q&A
50
Save the date!
Health Innovation Summit 2022Washington, DC
October 31 – November 3, 2022
Thank you