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How to Prepare for HEDIS® Reporting Season 2020 and Beyond

by Courtney Breece, Senior Director of Product Development, on December 5, 2019
Courtney Breece, Senior Director of Product Development

The upcoming HEDIS® reporting season is quickly approaching, and you have no doubt started reviewing the new HEDIS measures and learning what you can about measure and guideline changes to prepare for 2020.

But it can be overwhelming to sort through the new and revised measure specifications and guidelines to determine where your team should target time and resources. Some changes are more impactful than others – some present more challenges while others alleviate burden.

We have identified a few changes with major implications to help you understand their impact and what you can do to prepare for a successful HEDIS reporting season in 2020 and beyond.

HEDIS Schedule Change: Embrace the Gift of Time

WHAT IS CHANGING? NCQA is publishing complete HEDIS measure specifications sooner.

It’s no secret that HEDIS measurement and reporting is time consuming and burdensome. With HEDIS measure specifications published halfway through the 2019 measurement year, health plans and HEDIS certified vendors found themselves in a race against the clock preparing and updating software to incorporate new measures and measure specification changes. Starting measurement year 2021, health plans and vendors alike will have more time to understand and prepare for new measurement specifications and changes. NCQA has traditionally released HEDIS measure specifications in July of the measurement year – a 6-month lag. For instance, measure specifications for measurement year 2020 will be released July 1, 2020. However, for HEDIS measurement year 2021, measure specifications will be published July 1, 2020, giving health plans and vendors a 6-month head start to prepare. After this transition year, measure specifications will be released 5-months prior to the measurement year on August 1.

Current Timeline (HEDIS MY 2020) Transition Year (HEDIS MY 2021) Future Timeline (HEDIS MY 2022)
Volumes 1 & 2 Publication Date July 1, 2020 July 1, 2020 (Combined with HEDIS MY 2020) August 1, 2021
Vol. 2 Update Publication Date October 1, 2020 March 31, 2021 March 31, 2022
HEDIS Vendor Certification Deadline February 15, 2021 October 1, 2021 July 1, 2022

Connect with your vendor to learn when software updates will be completed so you can adjust your timeline accordingly and shift resources appropriately to prepare to receive data sooner. Additionally, the 5-month head start gives plans more stability in planning interventions for the year.

Challenges of Excluding Deceased Members

WHAT IS CHANGING? Members who died during the HEDIS measurement year may be excluded from all measures, except the measures in the Health Plan Descriptive domain or the Risk Adjusted Utilization subdomain. However, if a member dies during the measurement year, the organization is not required to remove the member from all measures.

Your voice has been heard! Deceased members may now be excluded from HEDIS measures, but we still don’t know how prevalent this change will be. Plans will likely be impacted in different ways depending on the quality of their data and the mix of their membership. So, if you choose to exclude deceased members, tread carefully. Doing so will require additional research and time to collect primary source data to identify members who have died in the measurement year. Closely review your data, available resources and membership mix and work with your auditor to determine whether the resulting outcomes of excluding deceased members is worth the extra effort and resources.

Preparing for Publicly Reported ECDS HEDIS Measures

WHAT IS CHANGING? In September 2019, NCQA announced that Prenatal Immunization Status (PRS) will be the first publicly reported Electronic Clinical Data System (ECDS) measure. Health plans will use the measure in HEDIS Measurement Year 2020 and report the results in June 2021.

Electronic Clinical Data System (ECDS) reporting is touted as the “Future of HEDIS.” Buzz around the industry on the need to improve health data system interoperability and utilize health information technology for quality measurement and reporting has become widespread – and continues to grow. These are two concepts that ECDS was designed to promote, but adoption of ECDS measures has been slow in part because reporting ECDS measures has been optional and those plans that have reported have faced some challenges.

NCQA Criteria for Publicly Reported ECDS Measures:

  1. An adequate number of health plans have shown they can report the measure
  2. Measure results match expectations based on other sources
  3. Results seem indicative of true performance
  4. Performance indicated an opportunity for improvement for the industry overall

While it’s true that few health plans have voluntarily reported on ECDS measures, there has also been significant variability across plans that have reported, with many finding it difficult to find and incorporate ECDS data sources – challenges that can be attributed largely to interoperability issues and electronic health records that lack the required data to report on the measures. These hiccupps are in addition to the fact that most of the current ECDS measures have not yet met the stringent criteria set forth by NCQA that must be met before public reporting becomes a requirement.

But the grace period on voluntary reporting for ECDS is almost over. This is possibly the last year when reporting on ECDS measures will not be required. One measure — Prenatal Immunization Status (PRS) — has met the criteria to be publicly reported, so health plans that haven’t already should start planning and testing the PRS measure now to ensure smooth HEDIS reporting in 2021.

Tips for Stress-Free HEDIS Reporting

“Don’t practice until you get it right. Practice until you can’t get it wrong.”

HEDIS measurement and reporting is evolving, and you must adjust your strategies accordingly. Practice, practice, practice! For a stress-free HEDIS reporting season, plan, practice and perfect your quality processes, strategies and initiatives to ensure success.

Plan: Engage your auditor for 2020 planning now, generate prospective rate runs and develop a complete project plan.
Practice: Determine and test chart pursuit logic. Test and QA projects thoroughly.
Perfect: Tweak chart pursuit logic as needed, review and update policies and procedures as necessary and evaluate and refine your processes, strategies and initiatives year-round.

For more tips, download our 3-in-1 2020 HEDIS reporting season checklist for success, audit timeline and calendar.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
MY: Measurement Year
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