Part One: Everything You Need to Know About HEDIS®

Every year, NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS®) to ensure that HEDIS measures remain relevant and feasible for implementation. These updates follow a rigorous process that includes a public comment period and input from advisory panels. 

Part One of this two-part blog on HEDIS outlines these changes during the transition from 2021 to 2022, which were released August 1, 2021. Keep in mind that this year’s HEDIS vendor certification deadline was Oct. 1, 2021, and next year the deadline will be July 1, 2022. The data submission process runs from November 2021 through October 2022.

For MY 2022, HEDIS added three new measures, retired three measures/indicators and changed seven existing measures.

Additions to HEDIS in 2022

The newest additions to HEDIS address patient-centered care, as well as safety and appropriateness: 

  • Advance Care Planning

    “The percentage of Medicare members 65-80 years of age with advanced illness, indication of frailty or receiving palliative care, and adults 81 years of age and older who had advance care planning during the measurement year.” This measure will allow plans to understand if advance care planning is provided to beneficiaries who are most likely to benefit from it.

  • Antibiotic Utilization for Respiratory Conditions

    “The percentage of episodes for members three months of age and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event.” This provides context about a health plan’s overall antibiotic use when viewed with three HEDIS measures of appropriate testing and inappropriate prescribing for upper respiratory infections, pharyngitis and acute bronchitis.

  • Deprescribing of Benzodiazepines in Older Adults

    “The percentage of Medicare members 65 years of age and older who were dispensed benzodiazepines and achieved a 20% decrease or greater in benzodiazepine dose during the measurement year.” This addition provides an opportunity to promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population.

Changes to HEDIS in 2022

  • Acute Hospital Utilization

    Revision to this risk-adjusted outcome measure excludes planned hospitalizations and updated it to remove separate Medical and Surgical reporting categories, retaining the total rate, which includes medical and surgical admissions.

  • Identification of Alcohol and Other Drug Services/Diagnosed Substance Use Disorders

    This has been revised from “utilization” to “diagnosed-prevalence” of substance use and updated the name to Diagnosed Substance Use Disorders. 

    NCQA also revised the measure denominator to reflect the number of members, rather than member years, and to include substance use disorder codes; and revised the age groups for reporting to 13–17, 18–64 and 65+.

  • Mental Health Utilization/Diagnosed Mental Health Disorders

    NCQA revised the measure structure from “utilization” to “diagnosed-prevalence” mental health disorders and updated the name to Diagnosed Mental Health Disorders.

    To see the full list of changes, visit here. 

Cross-Cutting Topics

  • Race/Ethnicity Stratification

    Evidence shows that members of certain ethnic demographics don’t receive the same quality care compared to the rest of the population. HEDIS 2022 adds this stratification to the following measures: Colorectal Cancer Screening, Controlling High Blood Pressure, Hemoglobin A1c Control for Patients with Diabetes, and Prenatal and Postpartum Care.

    These measures currently show in Evoke360. In 2022, these will refresh and continue to show along with the other measures for HEDIS. 

  • Electronic Clinical Data System (ECDS) Reporting

    NCQA will allow voluntary ECDS reporting for three HEDIS measures: Childhood Immunization Status, Immunizations for Adolescents and Metabolic Monitoring for Children and Adolescents on Antipsychotics.

Retired Measures

  • Care for Older Adults

    This clinical topic is now addressed in the new Advance Care Planning measure.

  • Comprehensive Diabetes Care

    HbA1c Testing indicator. NCQA will concentrate efforts on the outcome based HbA1c Control for Patients With Diabetes measure.

  • Antibiotic Utilization

    This measure has been retired. NCQA now collects the new Antibiotics for Respiratory Conditions measure.  

HEDIS Refresher

For those unfamiliar with HEDIS, this government measurement tool is used by more than 90 percent of health payers to assess and collect data on the performance of providers. Payers receive a score from the government, with significant Medicare financial incentives for providers and insurers if a score exceeds certain thresholds. 

HEDIS consists of quality measures created by the National Committee for Quality Assurance (NCQA). This data is tracked from year to year to measure health plan performance and provides valuable information about the patient populations served. The measures track the actual care received, and not just what was ordered. HEDIS measures effectiveness of care, access/availability of care, utilization, risk adjustment utilization and use of electronic clinical data systems.

As measures grow and change so does DataLink. We accurately reflect the current scores for each user according to their provider location. The reports refresh weekly to indicate progress to target. Changes are updated in our reporting engines, meeting providers right where they need us to most. 

In Part Two of our HEDIS series, we examine the impact of the COVID-19 pandemic on HEDIS.