This stratification program first introduced in MY 2022. URL of Specifications: N/A . Pay close attention to these quality measures during American Heart Month. The Breast Cancer Screening measure is also available in an ECDS format. Checking in on your mental health can be as easy as making an appointment with a mental health professional, such as a therapist or psychiatrist and that can be done face to face or virtually, said U.S. Air Force Lt. Col. Anna Fedotova, mental health flight commander, Kirtland Air Force Base, New Mexico. Samantha is the HEDIS program manager supporting Cotivitis Quality Intelligence solution. Sign up to get the latest information about your choice of CMS topics. Please visit ECDS webpageand NCQA Storefor more information. PDF 2022 Quality Rating System Measure Technical Specifications ThiseffortbuildsonNCQAsexistingworkdedicatedtotheadvancinghealthequityindataandqualitymeasurement. HEDISpublicationsareavailableas electronic publications. 2022 Cotiviti, Inc. All rights reserved. You can view ourPrivacy Policyfor more information. Candidate measures for MY 2022 include: Controlling High Blood Pressure (CBP) Comprehensive Diabetes Care (CDC) HbA1c <8% indicator Eye Exam Antidepressant Medication Management (AMM) Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC) Adults' Access to Preventive/Ambulatory Health Services (AAP) HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and sampling. You will be prompted to log in to your NCQA account. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status, HEDIS Electronic Clinical Data Systems (ECDS) Reporting, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC), Appropriate Testing for Pharyngitis (CWP), Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR), Pharmacotherapy Management of COPD Exacerbation (PCE), Persistence of Beta-Blocker Treatment After a Heart Attack (PBH), Statin Therapy for Patients With Cardiovascular Disease and Diabetes (SPC, SPD), Kidney Health Evaluation for Patients With Diabetes (KED), Osteoporosis Testing and Management in Older Women (OMW), Antidepressant Medication Management (AMM), Follow-Up Care for Children Prescribed ADHD Medication (ADD), Follow-Up After Hospitalization for Mental Illness (FUH), Follow-Up After Emergency Department Visit for Mental Illness (FUM), Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA), Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder (SSD, SMD, SMC), Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA), Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM), Pharmacotherapy for Opioid Use Disorder (POD), Follow-Up After High-Intensity Care for Substance Use Disorder (FUI), Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC), Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS), Non-Recommended PSA-Based Screening in Older Men (PSA), Appropriate Treatment for Upper Respiratory Infection (URI), Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB), Use of Imaging Studies for Low Back Pain (LBP), Medication Management in Older Adults (DDE, DAE), Use of Opioids from Multiple Providers (UOP), Management of Urinary Incontinence in Older Adults (MUI), Medical Assistance with Smoking and Tobacco Use Cessation (MSC), Pneumococcal Vaccination Status for Older Adults (PNU), Adults Access to Preventive/Ambulatory Health Services (AAP), Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET), Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP), Child and Adolescent Well-Care Visits (W30, WCV), Identification of Alcohol and Other Drug Services (IAD), Antibiotic Utilization for Respiratory Conditions (AXR), Hospitalization Following Discharge From a Skilled Nursing Facility (HFS), Hospitalization for Potentially Preventable Complications (HPC), Follow-Up Care for Children Prescribed ADHD Medication (ADD-E), Depression Screening and Follow-Up for Adolescents and Adults (DSF-E), Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (EMS-E), Depression Remission or Response for Adolescents and Adults (DRR-E), Unhealthy Alcohol Use Screening and Follow-Up (ASF-E), Prenatal Depression Screening and Follow-up (PND-E), Postpartum Depression Screening and Follow-up (PDS-E), Order the HEDIS MY 2023 Digital Measures Bundle, HEDIS MY 2023 Medication List Directory (NDC codes), HEDIS MY 2023 Measure Trending Determinations, HEDIS Electronic Clinical Data System (ECDS), HEDIS for the Quality Rating System Value Set Directory, HEDIS for the Quality Rating System Technical Specifications, Technical Specifications Update for the Quality Rating System, Order the HEDS MY 2022 Digital Measures Bundle (includes HEDIS Volume 2), HEDIS MY 2022 Medication List Directory (NDC codes), HEDIS MY 2022 Measure Trending Determinations, MY 2022 Validated Member-Level File Layout, HEDIS MY 2021 Measure Trending Determinations, MY 2021 Validated Member-Level File Layout, HEDIS MY 2020 Volume 2 Technical Specifications Update, NCQA HEDIS Measurement Year (MY) 2020 Requirements and COVID-19, HEDIS MY 2020 Medication List Directory (NDC codes), HEDIS MY 2020 Measure Trending Determinations, MY 2020 Quality Rating System Value Set Directory, MY 2020 Quality Rating System: Technical Update, MY 2020 Volume 3 Technical Specifications Update, Volume 3 MY 2020 Validated Member-Level File Layout, HEDIS Volume 2 & Digital Measures Bundles Comparison, HEDIS 2020 (MY 2019) Vol. Close care gaps this Osteoporosis Awareness and Prevention Month with better member outreach. Tues/Thurs: 7:30 a.m. to 6:00 p.m. Public comment ended on March 11, but additional details related to NCQA proposed changes for HEDIS MY2022 can be found in the attached Fact Sheet or at HEDIS Public Comment NCQA. Our goal is a child will have 6 well-child visits during these 15 months. CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS) measures from Medicare Special Need Plans (SNPs). HEDIS data help identify performance gaps and establish realistic targets for improvement. HEDIS CHEAT SHEET 2022 - 2023 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Documented yearly for ages 3-17. NCQA is proposing several changes to measures related to acute hospitalization utilization, use of imaging studies for low back pain, mental health utilization, alcohol and drug use, and diabetes care for MY 2022. We report some of the measures in Calendar Year (CY) and some measures in Fiscal Year (FY). HEDIS measurement year 2023 documentation for Childhood Immunization Status (CIS). Initiation and Engagement of Substance Use Disorder Treatment; changed the measurefrommember-basedtoepisode-based; changed thedenominatortolengthenthenegativeSUDhistoryperiodfrom60daysto194daysandremoveEDvisitsandmedicallymanagedwithdrawalfromthenegativeSUDhistoryperiod;removed the numerator requirementthatpsychosocialtreatmentaccompanypharmacotherapy; and revisedtheagestratificationstoreflectages1864yearsand65+years. NCQA is looking for public comment on two specific diabetes measures as well as denominator changes that would impact all seven HEDIS measures related to diabetes. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Healthcare Effectiveness Data and Information Set (HEDIS), CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS, Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Pharmacotherapy Management of COPD Exacerbation, Persistence of Beta-Blocker Treatment After a Heart Attack, Osteoporosis Management in Women Who Had a Fracture, Follow-Up After Hospitalization for Mental Illness, Potentially Harmful Drug-Disease Interactions in Older Adults, Use of High-Risk Medications in Older Adults, Transitions of Care (Reporting began in HEDIS MY 2020), Chronic Condition Special Needs Plans (C-SNPs), Dual Eligible Special Needs Plans (D-SNPs), Institutional Special Needs Plans (I-SNPs). To learnmore, clickherefor a discussion ofthe stratification, how we arrived atthiscurrentpoint andFAQs. Intent:The 2019 American Geriatrics Society Beers Criteria recommendthat benzodiazepinesbeavoidedinolderadults. We monitor this metric on a monthly basis and make more appointments available when the measure shows we need to. 2022 Cotiviti, Inc. All rights reserved. NCQAintroducedraceandethnicitystratificationstofiveHEDISmeasures: Colorectal Cancer Screening, Controlling High Blood Pressure, Hemoglobin A1c Control for Patients with Diabetes, Prenatal and Postpartum Care, and Child and Adolescent Well Care Visits, NCQAplanstoexpandtheraceandethnicitystratificationstoadditionalHEDISmeasuresoverseveralyearstohelp, disparitiesincareamongpatientpopulations. Height, weight, BMI percentile (use Z68.51-Z68.54) and nutrition (97802, 97803, 97804) and physical activity counseling (Z02.5, Z71.82) Lead Screening in Children: Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status. More than 200 million people are enrolled in plans that report HEDIS results. performance. **The use of the Emergency Department Utilization (EDU) measure in the 2022 Ratings is pending approval of its public reporting decision in October 2021. weight column indicates the weight of the item (maximum value = 3) in the overall score calculation. Avoiding imaging tests like x-ray, MRI, and CT scans can prevent harm to patients and reduce health care costs. Evidence shows that many patients diagnosed with low back pain receive excessive medical tests that can lead to unnecessary worry and unneeded surgery. PDF 2022 Star Ratings Fact Sheet - Centers for Medicare & Medicaid Services Proposing modification of the denominator criteria for this measure by expanding the age limit from 50 to 74 years of age. For MY 2022, NCQA proposes to expand ECDS reporting for: Childhood Immunization Status (CIS) Immunizations for Adolescents (IMA) and Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM). Confidential Mental Health Resources Available to Military Families. The percentage of episodes for members 3 months of age and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event. This HEDIS measure assesses women 5074 years of age who had at least one mammogram to screen for breast cancer in the past two years. Sentinel Events are those that result in harm or death to a patient. ThiseffortbuildsonNCQAsexistingworkdedicatedtotheadvancinghealthequityindataandqualitymeasurement. Clinical Documentation In it for the long haul, Datavant Closes Ciox Merger, Announces Launch of Datavant Switchboard, Oscar Health Renews and Expands Relationship with Digital Solutions Platform Provider Ciox Health, FAQs on Medicaid Redetermination, Unwinding, Eligibility, Enrollment, PHE, and CHIP, Sentara Healthcare and Ciox Launch Pilot on White House Initiative to Help New Mothers Access their Medical Records Faster and Easier to Improve Care, Antidepressant Medication Management (AMM), Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC), Adults Access to Preventive/Ambulatory Health Services (AAP), Well-Child Visits in the First 30 Months of Life (W30). Expansion of race and ethnicity stratification, updates to advance gender-inclusive quality measurement, changes to diabetes-related measures, and several measure retirements are among the changes just proposed to the HEDIS program by the National Committee for Quality Assurance (NCQA). NCQA also revised themeasuredenominatortoreflectthenumberofmembers,ratherthanmemberyears, andtoincludesubstanceusedisordercodes; andrevisedtheagegroupsforreportingto1317,1864and65+. Take a deep dive with Cotiviti into 2023 Star Ratings as we explore how we got here, share observations, and discuss strategies and interventions. Each year, NCQA looks to the public for feedback on proposed changes to HEDIS guidelines to determine the relevance and feasibility of new and revised measures. HEDIS includes measures for physicians, PPOs and other organizations. You can see for yourself how well we are doing. What we measure. Calendar years begin on January 1st. Additionally, NCQA has prioritized Cervical Cancer Screening (CCS) and may allow optional ECDS reporting for this measure in MY 2023. HEDISpublicationsareavailableas electronic publications. NCQA revised this risk-adjusted outcome measure to exclude planned hospitalizations and updated it to remove separate Medical and Surgical reporting categories, retaining the Total rate (which includes medical and surgical admissions). Click on one of the links to learn how we measure our performance. Replacing references to HbA1c in the measure with glycemic status.. From disease rates to maternal outcomes to overall life expectancy, significant disparities in he. Click Privacy Settings to see the types of cookies used and to update your cookie preferences for this browser. When identifying diabetes from claim/encounter data, plans should: Check for two diagnoses of diabetes on different dates of service in the measurement year (MY) or prior year (PY). Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks. Use of Imaging Studies for Low Back Pain (LBP), Identification of Alcohol and Other Drug Services & Mental Health Utilization (IAD), Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET), Follow-Up After Emergency Department visit for Alcohol and Other Drug Abuse or Dependence (FUA). lock NCQA has recommended 5 HEDIS measures be included beginning MY2022 with expectations to expand across a minimum of 15 measures by MY2024. Copyright 2023 National Committee for Quality Assurance. All proprietary information shall remain the sole and exclusive property of Cotiviti, Inc. introduce race and ethnicity stratifications to five HEDIS measures, NCQA publishes proposed changes to HEDIS measures for MY 2022, Remove reporting of separate medical and surgical categories, retaining just the total hospitalization rate, Expand the upper age limit from 50 to 74 years, Apply four additional clinical exclusions: any history of osteoporosis; any history of spinal surgery; any history of ankylosing spondylitis; and fragility fracture within 90 days prior to index date, Apply two cross-cutting exclusions: palliative care and advanced Illness/frailty, Change from utilization to diagnosis prevalence, follow the reporting guidelines for Effectiveness of Care Measures, Consider mental health diagnosis from any position (instead of principal only), Remove mental health practitioner requirements, Change from utilization to diagnosis prevalence, follow the reporting guidelines for Effectiveness of Care Measures, Change to episode-based instead of member-based, Add stratification for behavioral health complexity , When categorizing the drug cohort, choose the principal diagnosis or the position closest to the principal position, Update denominator and numerator criteria to look in any diagnosis position, Add additional follow-up options to numerator that dont require an SUD diagnosis, Move the optional exclusions to required exclusions. NCQAs HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications. If you arent sure if you have an appointment, call your mental health provider and schedule one. Some dont provide services that can result in a Sentinel Event. Osteoporosis is responsible for an estimated two million broken bones per year, yet nearly 80% of o, Learn how to improve health equity with better data collection and targeted member engagement. Lets use the Colorectal Cancer Screening (COL) measure as a practical example of what this means to health plans. Measurement Year 2020 and 2021 specifications included eight digitized versions of existing measures reported using the traditional method, and 11 measures specified using the ECDS format. Data shown for this HEDIS measure is the most recently approved by NCQA. High-qualityhealthcaremustbeequitablehealthcare. Watch our video as Cotiviti summarizes the major changes NCQA has proposed for the HEDIS program. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). As NCQA continues to transition measures to the electronic clinical data systems (ECDS) reporting standards, Cotiviti offers four strategies that can help. For Breast Cancer Screening (BCS), members assigned male at birth who have participated in gender-affirming estrogen therapy for at least five years would also be included in the measure. Intent:Antibiotics prescribed for acute respiratory conditions are a large driver of antibiotic overuse. The Breast Cancer Screening measure is also available in an ECDS format. Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives. MentalHealthUtilization/DiagnosedMentalHealthDisorders. This State of Healthcare Quality Report classifies health plans differently than NCQAs Quality Compass. The process of updating measures to take advantage of delivery system capabilities and the new digital future is underway.[15]. The HEDIS measures and specifications were developed by and are owned by NCQA. A higher number is better. Measure Type: HEDIS PQI Survey A strep test is the definitive test of group A strep pharyngitis. HEDIS/CAHPS Measures Required for HP AccreditationMedicaid Data shown for this HEDIS measure is the most recently approved by NCQA. Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM), Follow-Up Care for Children Prescribed ADHD Medication (ADD), Choose ECDS or Admin reporting for MY 2022, ECDS only MY 2023, Choose ECDSorHybrid reporting for MY 2023, ECDS only MY 2024 (Hybrid removed). 2018. All facilities in the MHS Direct Care system voluntarily report their patient safety events to the MHS Patient Safety Program. Measures relate to many significant public health issues such as cancer, heart disease, behavioral health and diabetes. The measure would be renamed Glycemic Status Assessment for Patients With Diabetes (GSD) with the following changes: Hybrid reporting would be removed from the measure, which would transition to administrative only. Taking a gradual approach to the rollout of digital measures, NCQA is involving stakeholders, analyzing results and encouraging dual reporting. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Implementing a more table-focused structure (similar to the existing structure of ECDS measure specifications) with more simplified language, Adding the General Guidelines text into each applicable measure specification, Noting whether the measure is person or event-based and the attribution bases of the measure (e.g., enrollment, claim/event), Listing the data types that the value set codes may be found within (e.g., the Mammography value set may be found in claim and observation data). With the intent to identify and reduce disparities in patient populations, one of the proposed changes is the introduction of race and ethnicity stratifications. This measure sees if military children have timely, easy access to health care services. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 1 This table contains the measures and brief descriptions that are included in HEDIS MY 2022. Three numerators: 10% Reduction, 25% Reduction, 50% Reduction. With the goal of "[advancing] health equity by leveraging HEDIS to hold health plans accountable for disparities in care among their patient populations," NCQA is looking to add at least five measures to its existing list of 13 measures that are stratified by race and ethnicity. InitiationandEngagementofAlcoholandOtherDrugAbuseorDependence. PDF HEDIS VOLUME 2 MY 2022 - National Committee for Quality Assurance and Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM). Removing the required exclusion for polycystic ovarian syndrome, gestational diabetes, or steroid-induced diabetes in the MY or PY with no diagnosis of diabetes. Some documents are presented in Portable Document Format (PDF). For your convenience we have categorized these in the below sections: The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication for at least 84 days (12 weeks). That makes HEDIS one of health cares most widely used performance improvement tools. HEDIS Expansion of Digital Measures: Preparing for 2022 Reporting by In 2015, the National Committee for Quality Assurance (NCQA) initiated a multi-year process to transform Healthcare Effectiveness Data and Information Set (HEDIS) quality measurement, beginning with the specification of the first Electronic Clinical Data Systems (ECDS) measure. OC'\r2'"_PlWi; OG[~RZK;|~L+9RqS9"^IZfjT'w C;OF-FsP0]uqqpAq_KJ23. Digital measures are intended to make measure specifications easier to work with, and continue to be a key theme for NCQA. As part of a larger strategy to encourage and improve health information exchange, NCQA also proposes removing traditional reporting from measures currently specified for ECDS. HEDIS Adult Pocket Guide: 2022 Measurement Year - Wellcare Appropriate Testing for Pharyngitis (CWP), Appropriate Treatment for Upper Respiratory Infection (URI), Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB), Childhood Immunization Status (CIS-E)[4][5], Depression Remission or Response for Adolescents and Adults (DRR-E), Depression Screening and Follow-Up for Adolescents and Adults (DSF-E), Follow-Up After Emergency Department Visit for Mental Illness (FUM)[6], Follow-Up Care for Children Prescribed ADHD Medication (ADD-E), Immunizations for Adolescents (IMA-E)[7][8], Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)[9][10], Non-Recommended PSA-Based Screening in Older Men (PSA), Postpartum Depression Screening and Follow-Up (PDS-E), Prenatal Depression Screening and Follow-Up (PND-E), Unhealthy Alcohol Use Screening and Follow-Up (ASF-E), Use of Opioids from Multiple Providers (UOP), Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E), Additionally, NCQA has indicated Cervical Cancer Screening may be eligible for ECDS reporting beginning in MY2023.[12]. or This measure is a facility specific one that shows you what sentinel events occurred in individual hospitals or clinics. HEDIS measures performance in health care where improvements can make a meaningful difference in peoples lives. HEDIS 2022: See What's New, What's Changed and What's Retired
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