NCQA Updates, Adds HEDIS Performance Measures for Plan Year 2019

July 06, 2018 - The National Committee for Quality Assurance (NCQA) has released updates to its HEDIS performance measures for plan year 2019. The refresh includes several new measures to guide population health management initiatives, as well.  

NCQA added four new measures to address emerging care concerns related to public safety and national healthcare challenges.

One new measure tracks hospitalizations after admission to a skilled nursing facility. NCQA believes this measure will help address care quality concerns for older beneficiaries and the nation’s growing Medicare Advantage population.  

“A growing number of Medicare Advantage beneficiaries require skilled nursing services, yet there is no measure assessing outcomes for this vulnerable population,” NCQA said. “This measure assesses the coordination of providers and services to support a successful transition to the community from a skilled level of care across Medicare Advantage plans.”

Another new measure will record patients over the age of 18 with an increased risk for opioid abuse.

The measure uses two indicators to report risk. The first records the percentage of beneficiaries with new episodes of opioid use that last 15 days out of a 30-day period. The second records the percentage of beneficiaries whose new episode of opioid use lasts at least 31 days out of a 62-day period.

The new measure could help prevent opioid use disorder and overdoses because patients given non-cancer opioid treatments have a higher risk of developing opioid dependency.

Two additional measures are designed to make it easier for administrators to submit quality performance information through the HEDIS Electronic Clinical Data Systems portal.  

The first measure records prenatal immunization status to help record if expectant mothers are receiving vaccines against influenza, tetanus, and diphtheria. The second measure records other adults receiving immunization against pneumococcal disease, pertussis, and herpes zoster.

Four HEDIS measures will be revised for the new 2019 set, according to NCQA.

The “controlling high blood pressure” measure will now use a reading of 140/90 to determine if adults between 18 and 65 are experiencing hypertension. The change comes after the American Heart Association changed its clinical recommendations to more accurately assess hypertension risk.

NCQA is also updating measures related to follow-up ED visits and hospital admissions for mental illness, as well as all-cause hospital readmissions. The changes add new qualifying events for mental illness-related readmissions and remove high frequency hospitalizations from risk-adjusted performance rates.

The 2019 measures will now exclude older beneficiaries (65 and older) with terminal illnesses from population health measures.

NCQA would remove terminally-ill beneficiaries from measures related to breast cancer screening, colorectal screening rates, comprehensive diabetes care, controlling high blood pressure, and disease-modifying anti-rheumatic drug therapy.

The organization explained that removing older and frail beneficiaries from general population health measures could help providers better manage populations with specialized care interventions.

“By implementing these exclusions, the frail and advanced illness population can focus on care that’s more appropriate for their conditions and health status,” NCQA said. “Attention will be focused on quality measures that capture services and care processes that are most relevant for this population (e.g., improving care transitions, getting follow-up after acute care episodes, or avoiding preventable hospitalizations).”