Opioid use disorder, telehealth, among NCQA updates to HEDIS quality measures
NCQA has introduced telehealth into 14 existing physical health measures for HEDIS 2019.
Specifications for opioid use disorder are among four new measures of the Healthcare Effectiveness Data and Information Set, or HEDIS, for 2019.
The National Committee for Quality Assurance released the new technical specifications on Monday. HEDIS is a widely used performance measure used by more than 90 percent of health plans.
The four new measures address emerging health priorities and evolving processes such as telehealth.
One assesses members who are at an increased risk of continued opioid use. Two rates are reported.
The first is the percent of members whose new episode of opioid use lasts at least 15 days in a 30-day period. The second is for opioid use that lasts at least 31 days in a 62-day period.
Another new measure assesses outcomes for the growing number of Medicare Advantage beneficiaries who require skilled nursing services.
A third assesses hospitalization following discharge from a skilled nursing facility and the percent of skilled nursing facility discharges that result in an unplanned hospitalization within 30 days and 60 days.
NCQA has added new measures to the HEDIS electronic clinical data systems reporting method on prenatal immunization status and adult immunization status.
Both measures assess the vaccines given to protect women and their infants from influenza, tetanus, diphtheria and pertussis. The adult immunization status also measures herpes zoster and pneumococcal.
The new HEDIS specifications include changes to four existing measures.
One revises the blood pressure target to <140/90 mm Hg for all adults age 18–85. NCQA has added telehealth encounters to satisfy certain components of the measure.
For the measure of follow-up after emergency department visit for mental illness, NCQA added a principal diagnosis of intentional self-harm and a principal diagnosis of intentional self-harm with a secondary diagnosis of a mental health disorder.
In plan all-cause readmissions, the measure will now include observation stays as index hospitalizations and readmissions events.
The measure also will remove individuals with high frequency hospitalization from the risk-adjusted readmission rate.
NCQA is publishing the revised plan all-cause readmissions measure alongside others released for HEDIS 2019, but is delaying implementation until 2020 due to the timing and use of the measure in the Medicare Advantage star ratings system of the Centers for Medicare and Medicaid Services.
Cross-cutting topics include telehealth for physical health measures. NCQA introduced telehealth into 14 existing physical health measures for HEDIS 2019, following on previous work to add telehealth services to behavioral health measures last year.
Quality measures that were designed and intended for a general adult population may not always be appropriate for those with limited life expectancy or advanced illness and frailty.
NCQA is implementing cross-cutting exclusions for individuals 65 and older who have an advanced illness and frailty or who live long-term in nursing home settings.
Four of these measures also exclude those age 80 and older with frailty: breast cancer screening, colorectal cancer screening, comprehensive diabetes care, controlling high blood pressure, disease-modifying antirheumatic drug therapy for rheumatoid arthritis, osteoporosis management in women who had a fracture, persistence of beta-blocker treatment after a heart attack; statin therapy for patients with cardiovascular disease and for patients with diabetes.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
