Standardization, Stability and Digital Innovation Journey are the key underlying messages that were highlighted in the NCQA HEDIS 2020 Summary of Changes. Altogether, the changes occur across few broad areas – Digital Measure Compatibility, Allowable Adjustment Rules, Measure Ruleset, Reporting, and Process changes. Introduction of ‘Allowable Adjustments’ across all clinical HEDIS measures should assist in greater adoption of HEDIS measures across industry entities and beyond usage of submission. With the enhanced share of ECDS measures in overall HEDIS program (along with wider adoption of ‘Digital Measure Compatibility’ through extended clinical value-sets) will further strengthen aggregation of clinical data as an alternate source, while balancing the overarching dependency on claims data.
The recently introduced 2020 first year measures are directed at arresting rising health issues such as women mental health during pregnancy, opioid and substance abuse amongst the generalized population. NCQA’s expressed interest to release measure definition 11 months ahead of HEDIS season will enable better planning and measure stability overtime. These changes should create a significant shift from traditional regulatory and operational reporting to a better holistic patient health quality management approach.
HEDIS 2020 summary of changes released in July 2019 from NCQA introduces 96 Measures spread across all Medicare, Medicaid and Commercial lines of businesses. Except for survey-based measures, all HEDIS measures have undergone modifications.
NCQA’s recommended and proposed changes for HEDIS 2020 are enlisted across few significant areas such as:
NCQA is following a two-prong strategy to actively pursue their Digital Innovation vision for defining HEDIS 2020.
ECDS measures promote expanded use of clinical data beyond traditional claims data and actively contribute towards meaningful clinical outcome measurement. Beyond 2020, the share of ECDS measures in HEDIS program could further rise. Currently there two significant quality programs that are managed with overlapping clinical measures:
Collaborative efforts are underway where both NCQA and CMS are working towards a common standardized ground through the introduction of Quality Data Model and Clinical Quality Language for a standard format for quality measure interpretation and implementation. Inclusion of clinical codes with traditional value-sets will expand the opportunities for clinical data acquisition and processing without the need to maintain complex crosswalks, thereby easing the data operations management.
Another key area is ‘Allowable Adjustments’ which will accommodate about 66 measures with new set of rules for modification and allow flexibility in altering the specified items as applicable for localized population scenario (e.g., enrollment criteria, changing the product line criteria, measurement period, population subsets).
Traditionally HEDIS specifications have been closely integrated for NCQA HEDIS program to prevent other industry entities like states, providers and government bodies from direct adoption and measurement, while representing the ecology of local population. Consequently, HEDIS like measures were created by other industry entities who adopted HEDIS measures with modified eligibilities and included value-sets to represent local needs while retaining measure clinical structure. With the introduction of ‘Allowable Adjustments’, the prevailing limitation and rigidness will be removed, and measures will become flexible for wider industry adoption without altering redundant duplication of HEDIS specification.
This will enable measure standardization across entities by retaining the measure clinical intent undisrupted while allowing multiple versions of HEDIS-like measures. Measures with added flexibility of “Allowable Adjustments” will be an important yardstick for industry wide performance benchmarking.
In the coming years, NCQA is proposing a schedule change to release the complete measure specs 11 months before the current timeline. Another significant proposed change is the redesign of the HEDIS IDSS submission file to make it available in two formats – XML (existing) and CSV format
The HEDIS 2020 Journey begins now.