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How to Develop HEDIS Quality Measures for Pediatric Care

The American Academy of Pediatrics provided guidance for developing HEDIS quality measures for pediatric care.

Healthcare Quality Measures

Source: Thinkstock

By Vera Gruessner

- The American Academy of Pediatrics (AAP) announced yesterday on its website that it will be partnering with the National Quality Forum (NQF) to connect quality metrics to the interests of children and pediatric care. The National Quality Forum looks to improve healthcare delivery through HEDIS quality measures.

The HEDIS quality measures from NQF are evidence-based metrics known as the “gold standard” within the healthcare industry. Payers utilize HEDIS quality measures to show where their health plans stand in order to help members decide what coverage options would best meet their needs. Both HEDIS quality measures and the metrics in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Core Set impact the healthcare delivery of pediatricians around the country, according to the AAP.

The National Quality Forum has released more than 300 HEDIS quality measures for payers and providers to meet over the years, which impact children’s healthcare in a variety of ways. At the end of last year, the Health and Well-Being Standing Committee reviewed 23 quality measures and recommended 15 of these metrics for endorsement.

The quality measures impact pediatric care by targeting childhood immunization statuses, preventive care and flu shots, and vaccination coverage among medical personnel. The American Academy of Pediatrics will continue participating in public comment periods regarding HEDIS quality measures and their impact on pediatric care.

This year the American Academy of Pediatrics released a report regarding the development of HEDIS quality measures and other healthcare metrics. Some significant difficulties of creating measures for pediatric care include gaps in evidence-based clinical decisions, making metrics age-specific for the majority of medical conditions, the large amount of resources necessary for developing quality measures, and the greater focus on adult conditions for measure development across the country.

READ MORE: Why HEDIS Quality Measures Matter for Value-Based Care

The report details how many resources are allocated to developing healthcare quality measures for the adult population, which takes up the majority of medical spending across the country. As such, much less investment has been made in pediatric quality measures.

While some healthcare quality measures may be applicable to both adults and children, payers, providers, and medical organizations will need to keep track of which metrics may be appropriate for adults but not for children.

“Although the development of pediatric-specific quality measures has intensified, it has not kept pace with the number and breadth of quality measures applicable to adults. Much of the focus and resources allocated to the development of quality measures have been, and continue to be, targeted toward the adult population, which accounts for most of the nation’s healthcare spending,” according to the report.

“It is important that all involved in the implementation of quality measures, such as national policy makers, healthcare organizations, payers, physician organizations, and pediatric health care providers, understand that measures that are appropriate for adults may not be suitable for children.”

There are specific differences between adult populations and pediatric populations including the financing of services, developmental changes, epidemiology, dependency, and demography, according to the report.

READ MORE: Top 3 Ways to Meet HEDIS Quality Measures, Improve Performance

Payers and providers can also overcome some of the struggles of pediatric quality measurements by investing more resources in developing childhood health metrics to track adult medical conditions that begin in childhood. Earlier intervention and identification of medical conditions could lead to better quality of pediatric care and better lifelong health outcomes, which could reduce total costs of care.

The American Academy of Pediatrics also encourages payers and other stakeholders to use evidence-based guidelines when developing healthcare quality metrics for pediatricians. An evidence review is often the first step where stakeholders identify and prioritize the top quality measures relevant to their patient population.

Feedback and comments from provider organizations as well as patients and their families will be key in finalizing any healthcare quality measures, the report states. Once healthcare quality measures have been finalized, the metrics are used for clinical quality improvement in terms of patient safety, timely and efficient care, better health outcomes, and an enhanced patient experience.

“I think there is a lot of information that the health plan has and power that the health plan has that the provider groups would like,” NCQA’s Vice President for Performance Measurement Mary Barton offered additional advice for payers regarding HEDIS quality measures.

“There could be a very virtuous cycle of events. If the health plan gives timely data about which patients have been hospitalized or had a diagnosis or medication ordered, providers would be able to use that timely information to manage that patient better. It’s an aligned interest. The practice wants to have that up-to-date information and the health plan wants the practice to improve their HEDIS scores.”

READ MORE: How Payers Can Improve HEDIS Quality Measure Performance

Healthcare payers and other stakeholders working to develop HEDIS quality measures for the pediatric field should consider following the steps outlined above to ensure strong clinical quality improvement.


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