HEDIS During and After the Pandemic

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.

https://www.ncqa.org/covid/#hedistelehealth

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


% R

eceiv

ed

Ma

mm

og

rap

hy

2018 2019 2020

-2.3

-4.7

-3.4


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


%w

ith S

tatin A

dhere

nce

2018 2019 2020


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


% F

ollo

w-u

p A

fter

7 d

ays

2018 2019 2020

4.7

3.2

3.0


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


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


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

https://www.ncqa.org/hedis/the-future-of-hedis/

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

https://www.ncqa.org/programs/data-and-information-technology/telehealth/taskforce-on-telehealth-policy/

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


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


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


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


https://www.ncqa.org/education-training/quality-innovation-series/

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


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


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


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


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


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


PAYMENTREPORTING

“Dear Partner

Org: Here are

the results we

can both trust."

MEASUREMENT

“I just want to

understand and

use a measure.”


42

WHAT


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?”


43

WHAT


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?”


44

WHAT


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?”


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

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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

HEDIS During and After the Pandemic

Documents

Transcript of HEDIS During and After the Pandemic