Part Two: Everything You Need to Know About Impact of COVID-19 on HEDIS®

The COVID-19 pandemic has underscored the critical importance of obtaining accurate data to inform policy decisions that could affect a broader population. In public health crises, accurate data represents a key factor in crafting responses, allocating resources, measuring the effectiveness of interventions and directing the reopening of local economies. 

NCQA continues to monitor the impact of the coronavirus pandemic on health plan business operations, including its potential effect on medical record data collection due to imposed travel bans, limited access to provider offices, quarantines and risk to staff. 

To support increased use of telehealth, NCQA updated telehealth guidance in 40 HEDIS measures for MY 2020 and MY 2021. For Health Plan Ratings 2021, NCQA implemented a special Overall Rating Policy for NCQA-Accredited plans: Ratings displayed the higher of the Overall Rating score between HPR 2021 and HPR 2019 for plans with current accreditation as of June 30, 2021. Individual measures, composites and subcomposites continue to be scored and displayed using HPR 2021 performance (i.e., MY 2020) for all plans.

For 2022, payers must take advantage of the pause now to implement the processes that will yield clean, concise and accurate clinical data.

Key Points

For commercial and Medicaid plans reporting to NCQA for measures using the hybrid methodology only, they will allow plans to report their audited HEDIS 2019 hybrid rate if it is better than their HEDIS 2020 hybrid rate as a result of low chart retrieval. 

Those submitting HEDIS 2019 hybrid rate for a hybrid measure should work with their auditor to ensure that the rate is accurately reported. No exceptions are being made for administrative rates which should be reported following HEDIS 2020 reporting requirements. 

It’s important to be aware that vaccination hesitancy has created a care gap. Closing this gap is essential to protect the nation’s most vulnerable populations and help them access the care they deserve. Encouraging real-world data on the effectiveness of vaccines is paramount, given that national statistics show vaccination campaigns have reduced the number of COVID-19-related deaths.

Getting Ahead of the Curve

During the temporary HEDIS reprieve payers can get ahead of the data-quality curve by working with a data management partner to ensure compliance with HEDIS. For instance, Evoke360 population health solution offers real-time data aggregation, EHR connectivity and dynamic dashboards and reporting to minimize up-front investment, deliver premier analytics and value-based intelligence, reduce costs, improve quality and care delivery, and enable efficient operations and network performance. 

DataLink remains flexible and responsive to all measure changes, accurately reflecting current scores for each user according to their provider location. Our reporting engines refresh every week so that we can meet provider needs at the point of care.

To learn more, visit our website.