NCQA QUALITY MEASURES AMID PANDEMIC AND RECOVERY – CHANGE AND MORE CHANGE

The COVID-19 pandemic has tested populations and healthcare systems across the country and around the world. In the U.S. alone, over 500k deaths have been attributed to the COVID-19 pandemic, with hospitals seeing record numbers of patients in ICUs and unprecedented bed shortages. In response to this global crisis, we saw the quickest development of effective vaccines in human history.

As our country, and the world begins to learn the full effects of COVID-19, healthcare analytics and reporting are highlighting some early learnings. It has been observed in the current National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS^®) reporting season that COVID-19 had a negative impact on multiple quality measures – the result of delayed preventive care and ambulatory visits. Today’s healthcare analytics not only allows for the measurement of these impacts but allows healthcare systems to manage patient populations and risk by improving intervention and efficiency of care. As we continue to experience changes in frontline healthcare, notably the use of telehealth, it is the reporting and analytics capabilities across the healthcare ecosystem that will continue to drive performance through accessible and actionable data, information, and insight.

As we approach the finish line of HEDIS MY 2020 submission, the certification of MY 2021 is starting. MY 2021 is a transition year in that the certification starts several months earlier than in the past; no later than June 1 and will end by October 1, 2021. This change in the schedule is welcomed because it enables HEDIS teams to proactively prepare for the upcoming HEDIS season and adapt HEDIS measure specification changes in the intervention program during the year. In MY 2022, and onward, the certification will start even earlier – March 2022.

As part of the transition year, there are very limited changes in MY 2021 measure specifications: no new measures, retirement of Disease Modifying Anti Rheumatic Drug Therapy for Rheumatoid Arthritis (ART), two health plan description measures, plus a few CIS combo measures. Please note that there are still changes in value code sets and NDC code changes in the Medication list. However, we estimate that nearly half of the measures will not have visible changes from MY 2020 to MY 2021.

This presents a great opportunity for quality teams to use existing measures produced by the certified MY 2020 engine to conduct intervention without concern that a targeted population will have significant changes. New approaches such as telehealth can also be implemented with quality measures in mind.

Interpreta’s Role

Interpreta will be deploying HEDIS, AMP, CMS, QRS, and state measures into user databases, serving over 20 million members, empowering our users to achieve the best quality outcomes for those they serve. Our seasoned technical and business experts are always ready to respond to user inquiries on measure updates, systems to support users in their intervention, audits, and submissions. We will continue to grow as a firm through our valued partnerships in the healthcare community while improving and innovating how Interpreta impacts quality and risk performance in our country’s healthcare system.