HEDIS During and After the Pandemic - September 30, 2021 Margaret E. O'Kane, President Sarah Shih, MPH, Assistant Vice President, Research & ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
HEDIS® During and After the Pandemic September 30, 2021 Margaret E. O’Kane, President Sarah Shih, MPH, Assistant Vice President, Research & Analysis Anne Smith, Assistant Vice President, Performance Measurement Brad Ryan, MD, Chief Product Officer
THE BIG PICTURE
HEDIS RESULTS: MEASUREMENT YEAR 2020
HEALTH EQUITY: A PILLAR OF HEDIS
DIGITAL MEASURES: MEASUREMENT YEAR 2022
Agenda DIGITAL SOLUTIONS: BUILDING BEYOND
HEALTH PLAN QUALITY REPORTING
The Big Picture by Peggy O’Kane
HEDIS results amid COVID in 2020
What happened to health plans’ performance in measurement years 2018-2020?
Adaptation
• Acceleration and Emergence of
Virtual or Remote Care
• Policy Changes to Payment
• Reduced Capacity for Social Distancing
Small shifts in performance
• Some decreases (expected)
• Some increases (surprising)
• Need for continued monitoring
4
NCQA responded early to COVID
Special policy for Health Plan Ratings
• Plans compared to current year benchmarks
• “Better of’ 2020 or 2021 overall rating
Updated telehealth guidance
• 40 HEDIS measures for MY 2020, 2021
(ncqa.org/covid/#hedistelehealth)
The World Health Organization declared COVID-19 a pandemic on 3/11/20.
5
Controlling High Blood Pressure (CBP) got worse
100.0
% with Hypertension with Blood Pressure
Breast Cancer Screening (BCS) got worse
100.0
90.0
-2.3 -3.4
80.0
72.0 72.9 73.4
70.5* 70.0*
% Received Mammography
70.0 -4.7
58.4 58.4
60.0
53.7*
50.0
40.0
30.0
20.0
10.0
0.0
Commercial Medicaid Medicare
2018 2019 2020
*Statistically significant
7
Statin Therapy for Patients with Cardiovascular Disease (SPC) – Adherence improved
100.0
4.9
90.0 2.1 85.5*
79.9* 3.8 80.6
80.0 76.3 77.8*
71.6*
70.0 67.8*
%with Statin Adherence
64.6
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Commercial Medicaid Medicare
2018 2019 2020
*Statistically significant 8
Follow-Up After Hospitalization for Mental Illness (FUH) improved
100.0
90.0
80.0
% Follow-up After 7 days
70.0
60.0
4.7
49.7*
50.0 45.0 3.2
44.2
39.6 3.0
40.0 35.8 36.4
30.6*
30.0 27.6
20.0
10.0
0.0
Commercial Medicaid Medicare
2018 2019 2020
Note: Follow-up After 7-days *Statistically significant
9Childhood Immunization Status (CIS) no change
100.0
90.0
80.0
% with Childhood Immunizations
0.8
70.0
60.0 55.2
54.4 0.7
52.3
50.0
38.2 38.9
40.0 35.2
30.0
20.0
10.0
0.0
Commercial Medicaid
2018 2019 2020
*Statistically significant
Note: CIS Combo 10 includes all recommended childhood immunizations. This measure has a 2-year look back period.
10Flu Vaccinations for Adults (FVA) widening gap
100.0
90.0
80.0
1.6
70.0
% with Flu Vaccinations
57.0 -3.8
60.0 55.4*
52.4
50.0
43.8*
41.8 40.0*
40.0
30.0
20.0
10.0
0.0
Commercial Medicaid
2018 2019 2020
*Statistically significant
Note: Data Source is from CAHPS survey 11Future of HEDIS
What’s next?
• Continue to monitor closely – Will there be delayed performance changes?
• Potential deeper dive – How has health care adapted with virtual or remote care?
• Identifying Disparities – Can we detect unwarranted differences?
• Share your stories and findings
12The future and our focus on health equity
6 themes
EASE INSIGHT
Digital Measures ECDS Reporting
ACCURACY EQUITY
See our Future of HEDIS Licensing & Closing
Certification Care Gaps
webinar series:
https://www.ncqa.org/
FLEXIBILITY ACCESS
hedis/the-future-of-hedis/ Allowable Telehealth
Adjustments
The Future
of HEDIS
146 themes
Allowable Adjustments
To give you flexibility in
how you use our measures,
we'll tell you their
allowable adjustments. FLEXIBILITY
Allowable
Adjustments
The Future
of HEDIS
156 themes
Licensing & Certification
ACCURACY
We’ll make sure uses of our Licensing &
Certification
measures are accurate and
reflect quality of care.
The Future
of HEDIS
166 themes
Digital Measures
EASE
Digital Measures
We’ll give you measures in a digital
format that’s easier to work with.
The Future
of HEDIS
176 themes
Electronic Clinical Data Systems (ECDS) Reporting
INSIGHT
ECDS Reporting
A new reporting method
helps clinical data create
insight.
The Future
of HEDIS
186 themes
Telehealth
Align. Adapt. Innovate.
See recommendations of our
Taskforce on Telehealth Policy:
ACCESS
ncqa.org/telehealth Telehealth
The Future
of HEDIS
196 themes
Equity
EQUITY
Closing care gaps to make Closing
Care Gaps
care equitable makes
care better.
The Future
of HEDIS
20EQUITY
Closing Care Gaps
High quality care is
EQUITY equitable care
principles No quality without
equity
that drive us
Build equity into all
NCQA programs
21What problems can we help resolve together?
Envisioning solutions EQUITY
Closing Care Gaps
INVESTIGATE ILLUMINATE ELEVATE
Defining Becoming Paying for
Equitable Equitable Equitable
Care Care Care
22Measures with Race and Ethnicity Stratification
Measures selected for MY2022 stratification EQUITY
Closing Care Gaps
Measure Product Lines Domain
Commercial,
Colorectal Cancer Screening (COL; COL-E)
Medicare
Effectiveness of
Commercial,
Controlling High Blood Pressure (CBP) Care
Medicaid, Medicare
Hemoglobin A1c Control for Patients With Commercial,
Diabetes (HBD) Medicaid, Medicare
Commercial, Access & Availability
Prenatal and Postpartum Care (PPC)
Medicaid of Care
Commercial,
Child and Adolescent Well Care Visits (WCV) Utilization
Medicaid
23Timeline for expanding stratification
Path forward EQUITY
Closing Care Gaps
Plans use direct data to degree available All plans: 80% direct
(supplement with indirect as needed) (potential indirect supplement)
5 measures total ≥10 measures total ≥15 measures total
MY 2022 MY 2023 MY 2024
First year
analysis of data
✓ Provides bridge from where we are to where we want to be
✓ Gives plans time to improve direct data collection
24Health Equity Accreditation: Coming October 5
Scoring aligns with Health Plan Accreditation. Look for an announcement email next week. EQUITY
Closing Care Gaps
Race/Ethnicity, Gender Identity,
Organizational Readiness Access and Availability of
Sexual Orientation and
and Promoting DEI Language Data Collection Language Services
Reducing Health Care
Practitioner Network Cultural and Linguistically
Appropriate Services Programs
Disparities
Responsiveness
(report stratified HEDIS measures)
25Want more details on HEDIS and equity? EQUITY
Closing Care Gaps
Registration:
ncqa.org/qiseries
26What’s new and what’s next with digital measures
Our vision for quality measurement
EASE
Measures that support QI at
Digital Solutions
multiple levels of the system
Expanded use of
electronic data Programs
use better
measures
Expanded
data access, BETTER
improved
content VALUE
and flow Measures
move beyond
Using technology
visit counts
to improve and low-bar
information process
available for
measurement
Meaningful, patient-centric
measurement strategies
28The digital quality ecosystem
Digital Quality Measures are the foundation EASE
Digital Solutions
Leverage more Foster patient- Align with Decrease
interoperability and
and better data specific care value-based measurement
into greater insight payment models burden
29NCQA’s Digital Quality Measure (dQM) work
EASE
Digital Solutions
HEDIS MY2020/2021 HEDIS MY 2022
• Released 19 dQMs using Quality Data • Released 22 dQMs using FHIR/CQL
Model (QDM)/Clinical Quality • Measures can be purchased
Language (CQL) individually
• Measures purchased in two bundles • Tested subset of measures against
Measure Certification test decks
2020 2021
Draft FHIR dQMs
• Released 5 draft dQMs using Fast Health
Interoperability Resources (FHIR)/CQL
30Digital measure packages for HEDIS MY 2022 released September 10!
Highlights and challenges
EASE
Digital Solutions
Highlights Challenges
Measures are in FHIR/CQL Adjusting to new data model
New data elements Learning curve for new
Common logic organized into resources (e.g., claims)
libraries Understanding complicated
Measure packages include logic/less human readable
value sets JSON files Pace for digitalization of
measures
32Digital Solutions: Building beyond health plan quality reporting
HEDIS is a
strong foundation
for digital solutions WHY
DIGITAL SOLUTIONS
W H AT
HOW
HEDIS
TRUST
Ubiquitous
Validated
Comparable
Consensus-driven
Evidence-based
191,000,000 covered lives
Billion$ in value-based payments
34WHY
Why evolve HEDIS? Why digital quality?
MEASURE
WHAT MATTERS,
REWARD BETTER
CARE
35What does digital enable? WHAT
WHAT:
3 PARTS
36Expanding what HEDIS enables WHAT
GOALS LEVELS FUNCTIONS
37Expanding what HEDIS enables WHAT
Supporting priority populations and topics
GOALS LEVELS FUNCTIONS
What you measure and
reward to get more of
Synonyms:
Priority, Area of Focus,
Strategic Center
Examples:
Broad: Improve health equity,
reduce measurement burden
Narrow: Control blood sugar
of teens who have diabetes
38Expanding what HEDIS enables WHAT
So you can find and reward quality at all LEVELS OF THE SYSTEM
GOALS LEVELS FUNCTIONS
PURCHASER
Reporting
Contracting
Reporting PAYER
Contracting
PROVIDER
CONSISTENT CONNECTED
Measures work similarly between levels Measure calculations roll up to the next level
39Expanding what HEDIS enables WHAT
So you can use it for FUNCTIONS other than reporting health plan quality
GOALS LEVELS FUNCTIONS
REPORTING PAYMENT
“Dear Partner
Org: Here are
the results we
can both trust.”
40Expanding what HEDIS enables WHAT
So you can use it for FUNCTIONS other than reporting health plan quality
GOALS LEVELS FUNCTIONS
MEASUREMENT REPORTING PAYMENT
“I just want to “Dear Partner
understand and Org: Here are
use a measure.” the results we
can both trust."
41Expanding what HEDIS enables WHAT
So you can use it for FUNCTIONS other than reporting health plan quality
GOALS LEVELS FUNCTIONS
MEASUREMENT MANAGEMENT REPORTING PAYMENT
“I just want to “How’m I doing? “Dear Partner
understand and ...And why?” Org: Here are
use a measure.” the results we
can both trust.”
42Expanding what HEDIS enables WHAT
So you can use it for FUNCTIONS other than reporting health plan quality
GOALS LEVELS FUNCTIONS
MEASUREMENT MANAGEMENT IMPROVEMENT REPORTING PAYMENT
“I just want to “How’m I doing? “How can we “Dear Partner
understand and ...And why?" get better?” Org: Here are
use a measure.” the results we
can both trust."
43Expanding what HEDIS enables WHAT
So you can use it for FUNCTIONS other than reporting health plan quality
GOALS LEVELS FUNCTIONS
MEASUREMENT MANAGEMENT IMPROVEMENT OPTIMIZATION REPORTING PAYMENT
“I just want to “How’m I doing? “How can we “How can I make “Dear Partner “What's the
understand and ...And why?” get better?” the most of my Org: Here are financial impact
use a measure.” improvement the results we of my quality
efforts?” can both trust." performance?”
44Here’s more on how digital works
HOW
DIGITAL:
2 PARTS
45Here’s more on how digital works
HOW
Digital Digital
CONTENT DELIVERY
What and how to measure How you ingest, implement and interact
with measures and content
New and different measures based on Eventually:
new and different data sources Digital measures as software
components (think: Spotify!)
Example: Example:
Tracking diabetes control through home FHIR/CQL measures that are
monitoring configurable and API-enabled
46Bringing it all
together...
Measure What
WHY
Matters
Reward Better Care
Meet Measure @ Enable more WHAT
diverse different measurement
GOALS LEVELS FUNCTIONS
Digital Digital
DELIVERY
HOW
CONTENT
47Questions
How to ask questions after today’s Q&A
Submit Your Question
PCS
Policy Program
Clarification Support
Ask a Question
My Questions
my.ncqa.org
Log in with Single Sign In
49Save the date!
Health Innovation Summit 2022
Washington, DC
October 31 – November 3, 2022
50Thank you
You can also read
