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NCQA Proposes New Changes to HEDIS Quality Measures in 2017

Health plans will need to work with providers to ensure that their network is meeting HEDIS quality measures and adhering to any new changes in the upcoming year.

By Vera Gruessner

The National Committee for Quality Assurance (NCQA) is looking to broaden a number of HEDIS quality measures for the 2017 edition, according to a news release from NCQA. These changes include the addition of four new HEDIS quality measures and revisions to another seven measures.

HEDIS Quality Measures

First, NCQA has proposed the reporting of healthcare-associated infection data from health plan’s network hospitals. The data will be collected via the CDC’s National Healthcare Safety Network (NHSN).

The type of infections that will be necessary to report include central-line associated infections, catheter-associated urinary tract infections, Clostridium difficile intestinal infections, and methicillin-resistant Staphylococcus aureus bloodstream infections.

The next proposed addition to the HEDIS quality measures includes follow-up visits after a patient visits an emergency department for a mental health issue. The follow-up visits are expected to be conducted at 7 days and 30 days after the emergency room visit. The same type of proposed measure has also been introduced for treating patients with drug or alcohol dependence.

Health payers may also be required to report any high-risk medications being used in the elderly especially with regard to any drug-disease interactions. Another proposed inclusion within the HEDIS quality measures is the management of fall risks among patients 65 years of age and older.

Additionally, vaccination status among older adults in need of pneumococcal vaccines will be revised to better fit the latest clinical standards. There are also changes being done to the use of imaging studies for low back pain as well as immunizations among children and adolescents including the human papillomavirus for  female adolescents.

According to a press release from the Exact Sciences Corp., NCQA is also adding a change to its colorectal cancer screening to include the practice of Cologuard. These changes to the HEDIS quality measures are expected to improve the quality of healthcare as well as boost patient health outcomes across the board.

“Inclusion in the HEDIS quality measures is an important milestone toward Cologuard becoming a standard of care for colon cancer screening,” Kevin Conroy, chairman and CEO of Exact Sciences, said in a public statement.  “Physicians, health systems and insurers would receive quality credit for using this patient-friendly screening option, which we believe will hasten its adoption.”

With more than 90 percent of health plans around the country utilizing HEDIS quality measures, these changes may make an impact on greater quality reporting and improved medical care much like the CMS Star Rating program.

There will be a 30-day public comment period allowed for these proposed HEDIS quality measures and any changes to the overall program. The public comment period will last until the middle of August.

Along with the clinical standards of the U.S. Preventive Services Task Force, NCQA will be using the most up-to-date information with regard to colorectal cancer screening recommendations. The new HEDIS quality measures will be implemented in 2017 after a more finalized version can be released.

"Primary care physicians and health plans are increasingly financially incentivized to demonstrate improvements in quality as measured by data, such as colon cancer screening rates," Mr. Conroy stated in the press release. "Cologuard's inclusion in HEDIS is an important step toward helping them achieve better quality scores."

With value-based care reimbursement becoming a more standard way of reimbursing providers today as payers move away from fee-for-service payment structures, the use of HEDIS quality measures will become more important in the country's focus on value-based payment. Health plans will need to work with providers to ensure that their network is meeting HEDIS quality measures and adhering to any new changes in the upcoming year. The future of the health insurance industry will likely remain committed to reporting HEDIS quality measures in an effort to improve patient health outcomes and ensuring better quality care.


Dig Deeper:

Top 3 Ways to Meet HEDIS Quality Measures, Improve Performance

Key Ways Blue Cross Blue Shield Raises its HEDIS Scores


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