NCQA Seeks Stakeholder Comments on Updated HEDIS Measures

February 15, 2018 - NCQA is seeking health plan, provider, and related stakeholder public comments to weigh in on updated HEDIS measures and the implementation of new measures related to chronic disease management.

NCQA wants to implement measures related to patient risks for opioid abuse, patients with multiple chronic conditions, long-term support services (LTSS), revisions to performance standards for measuring blood-pressure control, and metrics for hospital readmissions.

“NCQA reviews HEDIS measures to determine whether changes may be needed. NCQA convenes multi-stakeholder advisory groups—including independent scientists, clinicians, consumers and purchasers—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility,” the organization said.

A few of the newly proposed measures include assessments of chronic opioid use, the health of people with multiple chronic conditions, and LTSS service for Medicaid members

The Risk of Chronic Opioid Use measure determines that an adult is at high risk of opioid-use if the person uses opioids for 45 days within a three-month period. The measure is intended to observe the link between early prescribing patterns of opioids of acute pain and long-term use.

NCQA plans to add a Health Assessments for People With Multiple High-Risk Chronic Conditions measure that records if people with more than one chronic condition received adequate assessments and care management services. NCQA believes the measure can help identify gaps in care for extremely vulnerable patients and super-utilizers of healthcare.

NCQA also wants to add a new set of four Long-Term Services and Supports (LTSS) measures aimed at providing information about the quality of LTSS for Medicaid plans. NCQA developed the potential measures with help from CMS and the Mathematica Policy Research group.

“Person-centered care planning is critical to ensuring that adults with functional limitations and chronic illnesses receive care that helps them live as independently as possible,” NCQA said.

“These proposed new measures, will encourage transparency and accountability for organizations providing LTSS, including Medicaid plans and community-based organizations.”

The changes also include updates to performance indicators for controlling high blood pressure and recording follow-up ED visits for mental illness.

NCQA proposes to change the blood pressure target to <140/90 mm Hg for all patients 18–85 years of age with hypertension, based on review of clinical guidelines for patients with hypertension.

NCQA wants to add a diagnosis of potential patient self-harm to the Follow-Up After Emergency Department Visit for Mental Illness. NCQA found that many individuals that are admitted to the ED for self-harm usually receive a principal diagnosis for an injury and only a secondary diagnosis for self-harm.

The request for comment includes broad suggestions for allowing the use of telehealth to measure physical health HEDIS measures and measurement exclusions for health plan members with advanced illnesses.

NCQA reviewed previous stakeholder feedback about telehealth use and determined that with the right solution, telehealth provider use can accurately determine HEDIS performance for physical patient evaluations.

Excluding members with advanced illnesses from population-health based measures would prevent skew when measuring the healthcare status of broader patient groups, NCQA said.

Health plans and providers can read and comment on the proposed changes here and may submit comments until March 13, 2018.