The National Committee for Quality Assurance (NCQA) released new technical specifications for the 2015 edition of the Healthcare Effectiveness Data and Information Set (HEDIS).
Plans use the NCQA’s HEDIS measures to gauge effectiveness across a population. However, preferences concerning what drives quality healthcare for members vary, says John Santilli of Access Market Intelligence, which provides market intelligence to the pharmaceutical and healthcare industries.
“NCQA continues to address the issue that every payer requires its own set of measurements from providers in its recently released HEDIS updates,” Santilli says.
“While standardized measurements among payers is the exception, the new HEDIS measurements do address two pertinent issues in PSA screening and antipsychotic medications,” he says.
The new HEDIS technical specifications include four new measures and changes to several existing measures.
NCQA added Non-Recommended PSA-Based Screening in Older Men to the HEDIS measure set. This assesses the percentage of men 70 years and older who are unnecessarily screened for prostate cancer using prostate-specific antigen-based screening.
NCQA also added three measures that assess the safe and judicious use of antipsychotic medications in children and adolescents:
- Use of Multiple Concurrent Antipsychotics in Children and Adolescents: Assesses the percentage of children and adolescents who were on two or more antipsychotic medications for an extended period of time.
- Metabolic Monitoring for Children and Adolescents on Antipsychotics: Assesses the percentage of children and adolescents who have ongoing use of antipsychotic medications and had metabolic testing.
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics: Assesses the percentage of children and adolescents who had a new prescription for an antipsychotic medication without a primary indication for it and had documentation of psychosocial care as first-line treatment.
Changes to Existing Measures
Some measures were revised for HEDIS 2015:
- Controlling High Blood Pressure: NCQA added age and condition specific treatment goals that align with the eighth Joint National Committee hypertension guidelines:
o 18–59 years (<140/90 mm Hg).
o 60–85 years with diabetes (<140/90 mm Hg).
o 60–85 years without diabetes (<150/90 mm Hg).
- Comprehensive Diabetes Care: NCQA removed three indicators of quality from this measure: LDL-C Screening, LDL-C Control (<100 mg/dL) and Blood Pressure Control (<140/80 mm Hg). These changes align with new blood cholesterol guidelines of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and with new hypertension guidelines of the eighth Joint National Committee.
- Annual Monitoring for Patients on Persistent Medications: To align this measure with current evidence, NCQA retired the Anticonvulsant-Monitoring rate; revised the numerator for angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), Digoxin and Diuretics rates to remove blood urea nitrogen as a substitute for serum creatinine; and revised the Digoxin rate to include serum digoxin monitoring.
- Osteoporosis Testing in Older Women: To improve this measure’s accuracy, NCQA revised the survey question to specify that the bone density test would have been done in the back or hip, and added an upper age limit of 85.
- Osteoporosis Management in Women Who Had a Fracture: To align this measure with current evidence for osteoporosis prevention and treatment, NCQA revised the exclusion requirement to look back further for evidence of a Bone Mineral Density (BMD) test; added an upper age limit of 85; removed estrogens from the list of drug therapies; and removed pathologic fractures.
- Plan All-Cause Readmissions: To improve this measure’s accuracy, NCQA revised it to allow readmissions to serve as potential index admissions and added an exclusion for planned readmissions.
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey 5.0H: To align with other CAHPS survey instruments, NCQA revised the Shared Decision Making Composite response options from a four-point response scale to a two-point response scale.
Additionally, NCQA retired two measures to bring HEDIS up to date with current evidence:
- Glaucoma Screening in Older Adults.
- Cholesterol Management for Patients with Cardiovascular Conditions.
For more information, refer to the full specifications in HEDIS 2015, Volume 2.