The National Committee for Quality Assurance (NCQA) recently announced adjustments to 40 Healthcare Effectiveness Data and Information Set (HEDIS®) measures to support the use of video telehealth, telephonic telehealth and e-visits that occur virtually over a portal during the COVID-19 pandemic and beyond.

The adjustments were published in the HEDIS Volume 2 Technical Specifications on July 1, 2020 and include eight measures related to behavioral health—medication adherence, follow-up care after hospitalization or emergency department visits, and monitoring of co-occurring medical conditions in consumers with serious mental illness.

For each measure, the updated guidance specifies how telehealth visits can be used and what will be included and excluded in the measure’s denominator and numerator. Significantly, NCQA now recognizes a video visit as the same as an in-person visit. The new updates also imply that parity in telehealth coverage will carry forward to the post-crisis future.

Goals Remain the Same

The new NCQA adjustments do not change the key performance measures that payers, including the Centers for Medicare and Medicaid, states and health plans, require provider organizations to report. Payers will continue to look for access to care, resource utilization, and the experience and effectiveness of care. The key performance indicators—readmission rates, ambulatory care follow-up after hospitalization, utilization, consumer engagement and satisfaction—remain in effect.

Evoke360 Assists in Quality Improvement

Evoke360, which earned NCQA certification for the HEDIS Health Plan 2020 for all measures, delivers a 360-degree view of the patient and uses intelligent analytics to identify care gaps and closure opportunities for quality and risk adjustment. The solution offers real-time data aggregation that assists in quality improvement initiatives.

In terms of NCQA’s new adjustments around behavioral health, Evoke360 measures utilization, chronic conditions, medication adherence, emergency department visits and admissions, discharges and transfers (ADTs).

Evoke360 optimizes quality, reduces administrative burden, enables the transition to value-based care and enhances financial performance and communication with visibility into all health plan operations in one point-of-care solution.