What You Need to Know About Newly Released NCQA HEDIS® 2019 Technical Specifications and Measure Updates

August 14, 2018 - The Healthcare Effectiveness Data and Information Set (HEDIS®) is used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Each year, the National Committee for Quality Assurance (NCQA) gathers experts with clinical and technical knowledge in performance measure design to identify methodological issues, and provide improvement and feedback on new and existing measures. Those are incorporated into updated reporting, audit methodologies and measure changes so that the HEDIS® report accurately reflects the quality performance of reporting entities.

Interpreta was recently selected as one of just two NCQA Measure Certification℠ HEDIS® 2019 beta vendors after also serving in that role in 2018. As a beta vendor for the past two certification seasons, Interpreta works with these important healthcare performance measures daily. Here is a summary of the significant specification and measure changes NCQA put into place as of July 1. 

  • Socioeconomic status (SES) stratification is added to measure logic and outputs for four Healthcare Effectiveness Data and Information Set (HEDIS®) and CMS Star measures: BCS, COL, CDC-eye exam, PCR as part of efforts to understand factors that impact measure performance.

  • Telehealth codes are added to 16 measures. See change summary on individual measure level in the technical specification Volume 2, Appendix 1.

  • Exclusions for members with advanced illness and frailty for several measures were added to accurately measure applicable populations. Similar to this exclusion, last year NCQA introduced exclusion of Medicare members living in a long-term care setting and expanded it to several additional measures this year.

  • Certified Federally Qualified Health Center (FQHCs) can now be counted as primary care providers to achieve more consistency in rate reporting and incorporate recommendations from managed care organizations and auditors. Supplemental data is no longer used in numerators of overuse measure domain.

  • Four new measures have been introduced, multiple existent measures are updated, with most significant changes focused on measure for controlling blood pressure. More information on the new or updated measures can be found here.

  • ECDS measures are converted to a digital measure format.

  • NCQA also created guidelines on allowed adjustments to HEDIS® measures for business purposes other than audited submissions in an effort to modify HEDIS® measures and can still use HEDIS®name. HEDIS® measures can now be adjusted by users following these guidelines without compromising measure integrity.

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs, and other health-related programs. Since its introduction in 1993, the Healthcare Effectiveness Data and Information Set (HEDIS®) has evolved to become the gold standard in managed care performance measurement. For more information visit www.ncqa.org.

By Jiong Huang                                                                                                                                  
Vice President of Quality at
Interpreta

He can be reached at Jiong.huang@interpreta.com

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