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How to Impact HEDIS® Measurement Year 2020 and Beyond

by Courtney Breece, Senior Director of Product Development, on February 10, 2021
Courtney Breece, Senior Director of Product Development

HEDIS® measurement year 2020 (MY2020) has just begun and there’s still plenty of time to positively impact this HEDIS® reporting season. Amid the past year’s unprecedented challenges primarily resulting from the COVID-19 pandemic, NCQA made significant changes to the HEDIS® measurement and reporting guidelines in an effort to maintain focus on value-based quality care delivery – from advancing patient-centered access and continuity of care to performance measurement and quality improvement.

Here, we have identified key changes that carry major implications to help you understand their impact and what you can do now to achieve success in HEDIS® MY2020 and beyond.

Supplemental Data Exchange for Sample Measure Members

With an impactful change to General Guideline 32 (GG32) in the MY2020 Technical Specifications, health plans can now use clinical data exchange for supplemental data for hybrid HEDIS® measures on only those members in the medical record review (MRR) samples in their projects. Previously, supplemental data was required for a measure’s entire population. This will further decrease a health plan’s overall MRR costs, as it significantly reduces the number of MRR chases given that electronic clinical data exchange is already a more cost-effective way of clinical record retrieval compared to traditional MRR collection.

Figure 1: Clinical data extraction for quality reporting – then and now. HEDIS® General Guideline 32 removed the restriction that only allowed supplemental data to be collected on the eligible population.

Telehealth Allowances

To mitigate the spread of COVID-19, the healthcare industry quickly pivoted to virtual care in 2019 to keep both patients and healthcare workers safe. To that end, for HEDIS® MY2020, NCQA expanded acceptance of telehealth services for patient encounters in lieu of in-person visits.

“You cannot drive quality improvement if your measures don’t take into account what has quickly become the fastest growing modality for providing healthcare services.”

NCQA’s announcement of new telehealth accommodations for 40 HEDIS® measures signals that healthcare organizations understand the important role telehealth has played in enabling healthcare delivery amid a global pandemic and recognize the long-term benefits. Fortune Business Insights reports that the global telemedicine market size was $41.6 billion in 2019 and is projected to reach $396.8 billion by 2027. It’s likely organizations will continue to adapt their model of care to accommodate remote healthcare services as it continues to play an integral role in delivering care.

Palliative Care Exclusion

NCQA added a cross-cutting palliative care exclusion for 15 HEDIS® measures. These select measures fall into three categories: inappropriate medication use, screening and prevention, and disease-specific medical treatment. Many HEDIS® measures are created for the general population. Excluding palliative care members from these measures allows providers to focus on other quality initiatives and measures to improve the quality of life for members suffering from a serious illness.

The bottom line? Make sure you have identified these measures and updated your process as needed. Additionally, understand that excluding palliative care from these measures doesn’t mean the member shouldn’t get the care specific to these measures, rather it should be a shared decision among the member, their family, caregiver and provider.

Tips to Drive Improvements This HEDIS® Reporting Season

To ease the stress of HEDIS® MY2020 reporting, health plans should take advantage of the progressive changes NCQA has implemented and the opportunities they present.

  • Align your data collection strategy with the HEDIS® GG32 change to use supplemental data for hybrid measures on only those members in the medical record review sample in their HEDIS® project, versus the members in the measure’s entire population.
  • Expand the use of telehealth to improve access to care, close gaps in care, improve health outcomes and increase quality ratings.
  • Update processes to identify and exclude palliative care members from the applicable HEDIS® measures.

HEDIS® measurement and reporting is continually evolving, and you must adjust your strategies accordingly. For a stress-free HEDIS® MY2020, engage your auditor and perfect your quality processes, strategies and initiatives to ensure success.

Need guidance and support? Contact your product service manager (PSM) or contact us today.

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