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In the third episode of our “From the Trenches” podcast, we look at several new measures and measure changes recently proposed by the National Committee for Quality Assurance (NCQA) for next year’s HEDIS season and how they would impact health plans. NCQA recently held a month-long public comment period for health plans and other stakeholders to weigh in on the proposed changes.
Our guests on this episode are Jenna Fitcher, product director for Verscend’s Quality and Performance Solutions, as well as product manager Jamison Gillitzer. Listen here:
About the podcast:
From the Trenches is a new podcast from Verscend Technologies, a leader in healthcare data analytics, exploring the latest trends in healthcare quality and performance analytics, risk adjustment, payment integrity, and payer-provider collaboration. Check out all our episodes in your browser, or subscribe on your smartphone or tablet with Apple Podcasts, TuneIn, Google Play, and Stitcher.
About our guests:
Jenna Fitcher's primary responsibility is ensuring our solutions meet clients’ needs in support of HEDIS, Star Ratings, and other quality reporting initiatives. She also works to develop and maintain Verscend’s strategy and roadmap for ongoing initiatives.
Jamison Gillitzer’s primary responsibilities are the successful delivery of our quality solutions to ensure they meet clients' needs in support of HEDIS, P4P, and other quality reporting initiatives. He also works to develop and enhance our capabilities to support evolving quality requirements.
NCQA does an annual public comment period where vendors, auditors, and health plans can submit comments on proposed new measures. These measures changes would impact the next year’s HEDIS season. Public comment runs for about a month and it ended March 13. These are for measures that have final specifications that will come out in early July.
They have proposed nine new measures in all. The breakdown is:
On top of this, there were proposed changes to existing measures, which include:
For HEDIS 2018, NCQA added two new opioid measures: Use of Opioids at High Dosage (UOD) and Use of Opioids from Multiple Providers (UOP). The proposed addition of Risk of Chronic Opioid Use (COU) makes for the third new measure in two years centered on opioids. Suffice to say, through the addition of the new measures, NCQA is illustrating the importance of measuring, managing, and correcting the opioid epidemic we find ourselves facing today.
Yes, they also proposed:
The amount of new measures proposed this year is a bit higher, nine this year versus six last year. Overall, the amount of total changes proposed is about the same as last year.
For measures that we’re able to add or update using our current input layouts, Verscend does proactively begin coding the measures over the summer. This allows us to turnaround the certified version of the measures faster once we receive the final specifications.
New measures will be in a “first-year” status for HEDIS 2019. This means next year will be basically a trial run, and the measures won’t be required for reporting. However, all new measures and measure changes likely come with changes to the Verscend input specifications to capture new data elements. Plans will want to pay close attention to these changes when our input layouts are released in the fall to ensure they’re including all the necessary detail to accurately report on these new measures.
There were some much anticipated changes to the CBP measure this year. Historically, CBP has been a bit of a burden due to all compliance needing to come from hybrid chart review. This year, NCQA is proposing the addition of administrative specifications for compliance which should help ease this burden significantly.
Additionally, they’ve changed the blood pressure targets, so 140/90 would apply to all members as part of this measure, and also the medical record confirmation of hypertension was removed and replaced by two outpatient encounters with a diagnosis of hypertension during the first six months of the measurement year or year prior used to identify the denominator—again, easing the burden of chart review.
As these changes were much anticipated, we do plan to build out the CBP measure changes in the 2018 version of our solution for plans to test the logic changes. This will include a measure summary, measure detail, and drills for viewing the updated eligible populations and measure rates, but no data collection template or sampling.
Chart review, chart review, chart review. We are in the peak season for retrieval and abstraction and I know plans are feverishly working with the shortened timelines this season to get everything done on time.
How does Verscend work with health plans to transform annual quality reporting into a true strategic advantage? Take a look at our case study on planting the seeds for measurable quality improvement across CareOregon’s population.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Podcast music credit: "Inhaling Freedom" by Nazar Rybak, via HookSounds.