Healthcare Effectiveness Data and Information Set (HEDIS®) is widely used to ensure quality in managed care. However, a major challenge in ensuring high performance with HEDIS is addressing and interpreting ever-changing technical specification and implementing timely and effective action plans to address them.
To help navigate the 2020 HEDIS technical specification changes and the need for revised action plans, we were fortunate to have two nationally-recognized audit practice leaders–Tina Kind, Managing Partner at DTS Group and Jean Vertefeuille, CEO at Advent Advisory Group–speak at Interpreta’s webinar “HEDIS® 2020 Technical Updates: Hear from Industry Experts” recently, on September 26.
In this very informative webinar, Tina reviewed changes to general guidelines, and Jean highlighted measure level changes.
A few highlights include:
- Supplemental data requirement change – Continuity of Care Data (CCD) source will now be considered non-standard supplemental data and is subject to corresponding audit requirements, at least for the first year. NCQA has removed the requirement that supplemental data for hybrid measures must contain all hybrid data elements. However, because this is still an evolving process, reporting entities should work with their auditors on measure level/data source level verification.
- Guidelines for the rules of Allowable Adjustment of HEDIS – Are now incorporated in volume two in measure level specification.
- Global changes – Changes in practitioner type; exclusion code sets, type and criteria; and medication list format change. NCQA also expanded the use of Telehealth and SNOMED codes which is expected to significantly impact the future of HEDIS.
- Retired and partial retired measures announced – These include: Annual Monitoring for Patients on Persistent Medications (MPM), Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC), Standardized Healthcare-Associated Infection Ratio (HAI), Use of High-Risk Medications in the Elderly (DAE), Ambulatory Care (AMB), Inpatient Utilization—General Hospital/Acute Care (IPU), and Disease-Modifying Anti- Rheumatic Drug Therapy for Rheumatoid Arthritis (ART).
- New measures announced – These include: Follow-Up After High-Intensity Care for Substance Use Disorder (FUI), Pharmacotherapy for Opioid Use Disorder (POD), ECDS measures: Breast Cancer Screening (BCS-E), Colorectal Cancer Screening (COL-E), Follow -Up Care for Children Prescribed ADHD Medication (ADD-E), Prenatal Depression Screening and Follow-Up (PND), and Postpartum Depression Screening and Follow-up (PDS).
- Significantly revised measures – These include: Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB), Appropriate Treatment for Upper Respiratory Infection (URI), Appropriate Testing for Pharyngitis (CWP), Plan All-Cause Readmission (PCR), Cervical Cancer Screening (CCS), Prenatal and Postpartum Care (PPC), plus others.
Tina and Jean explained, in detail, their interpretations of HEDIS measure specification changes. They emphasized the need to not only consider specification changes at the measure level, but also review the general guidelines, since many changes are global and covered in detail in this section as well.
Interpreta’s real-time NCQA-certified engine can help to produce timely HEDIS alerts to quickly close gaps in care and achieve optimal quality outcomes for members. At Interpreta, we have always been a partner in improving quality for our clients.
Please contact your supporting team and Interpreta SME to take advantage of HEDIS updates and opportunities to enhance outcomes.
Listen to the full recorded webinar at “HEDIS® 2020 Technical Updates: Hear from Industry Experts.”
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).