The Healthcare Effectiveness Data and Information Set (HEDIS) is a popular performance improvement tool among health plans, for which four new measures were released by the National Committee for Quality Assurance (NCQA) for 2019.
According to the NCQA, the updates address “emerging health priorities and evolving processes in care delivery.”
The new measures include:
- Hospitalization after discharge from a skilled nursing facility: measuring the percentage of SNF discharges that result in unplanned hospitalizations within a 30 or 60-day time period.
- Beneficiaries over the age of 18 that are at risk for continued opioid abuse: the two indicators to reporting risk are percentage of patients whose new episode of opioid use lasts 15 days in a 30-day period or 31 days in a 62-day period.
- Prenatal immunization status: expecting mothers receiving recommended vaccinations.
- Adult immunization status: includes percentage of adults 19 years and older who are up to date on the recommended routine vaccinations like influenza and tetanus.
NCQA said this in a statement:
“A growing number of Medicare Advantage beneficiaries require skilled nursing services, yet there is no measure assessing outcomes for this vulnerable population. This measure assesses the coordination of providers and services to support a successful transition to the community from a skilled level of care across Medicare Advantage plans.”
There are also amendments to existing HEDIS measures that includes revisions to the blood pressure target for adults aged 18 to 85 and added telehealth encounters.
For follow-up after emergency department visit for mental illness, there is an added principal diagnosis of intentional self-harm. Observation stays will now be included as index hospitalizations and readmission events for all product lines as part of a plan all-cause readmissions.
“NCQA is publishing the revised Plan All-Cause Readmissions measure alongside others released for HEDIS 2019, but delaying implementation until HEDIS 2020. NCQA worked with the Centers for Medicare & Medicaid Services to identify this timeline, given the extent of the measure changes and use of the measure in the Medicare Advantage Star Ratings System.”
For the full description and list of changes, visit the NCQA site.
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