Blog /

NCQA Proposed Measure Changes for HEDIS 2022

Publish Date
Read Time
Kathryn Harsch
July 16, 2021

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. This blog post highlights the important details around the proposed changes and what plans can expect to report going into HEDIS Measure Year (MY) 2022.

Introduction of Race and Ethnicity Stratification

With the intent to identify and reduce disparities in patient populations, one of the proposed changes is the introduction of race and ethnicity stratifications. Using a 3-year phased approach to implement the stratification changes, NCQA’s stated goal is to require all plans to report measure performance by race and ethnicity using directly collected member data by MY2024. NCQA has recommended 5 HEDIS measures be included beginning MY2022 with expectations to expand across a minimum of 15 measures by MY2024.

A list of potential measures for initial stratification in MY2022 are as follows:

  • Controlling High Blood Pressure (CBP)
  • Comprehensive Diabetes Care (CDC)
  • 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)
  • Prenatal and Postpartum Care (PPC)
  • Well-Child Visits in the First 30 Months of Life (W30)
  • Child Adolescent Well-Care Visits (WCV)
  • Mental Health Utilization (MPT)

NCQA prioritized measures for possible inclusion if they represented a high-priority population for disparities, represented multiple HEDIS domains, and/or represented multiple product lines. The Health Expert Work Group, directed by NCQA, will continue throughout 2021 in gathering feedback as public comment responses are reviewed and stratification specifications are finalized.

Roadmap for Electronic Clinical Data Systems Reporting Method

Another proposed change will look at adding the Electronic Clinical Data Systems (ECDS) Reporting standard to three additional existing measures. 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).

Additionally, NCQA has prioritized Cervical Cancer Screening (CCS) and may allow optional ECDS reporting for this measure in MY 2023. Other noted changes will allow plans to choose ECDS or Admin reporting for MY 2022 and shift to ECDS only for MY2023 for both Breast Cancer Screening (BCS) and Follow-Up Care for Children Prescribed ADHD Medication (ADD). Similarly, we could see Colorectal Cancer Screening (COL) shift to ECDS only by removing the hybrid reporting method by MY2024.

ECDS was introduced in 2015 but NCQA still lists ECDS measure reporting as optional, giving health plans the choice to use traditional reporting. Recognizing that health plans are at different stages of health IT integration and multiple barriers may need to be overcome, NCQA will continue to implement actions to support the successful adoption of ECDS.

“These efforts are part of a greater strategy to reorient HEDIS to more and better use of electronic clinical data and encourage health information exchange, which will enhance our ability to measure and improve the quality of health care.” – NCQA

Proposed Changes to Existing Measures for MY 2022

Changes are proposed to several existing measures related to acute hospitalization utilization, use of imaging studies for low back pain, alcohol and drug use, mental health utilization, and diabetes care.

Acute Hospital Utilization (AHU)

  • Administrative Measure
  • Proposing to exclude planned hospitalizations and removing the reporting of separate medical and surgical categories (just reporting on the total hospitalization rate).

Use of Imaging Studies for Low Back Pain (LBP)

  • Administrative measure
  • Proposing modification of the denominator criteria for this measure by expanding the age limit from 50 to 74 years of age.
  • Four additional guidelines will be applied for clinical exclusions and applying existing cross-cutting exclusions for members with advanced illness/frailty and those that are in palliative care.

Identification of Alcohol and Other Drug Services & Mental Health Utilization (IAD)

  • Rename to Diagnosed Substance-Related Disorders

Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)

  • Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
  • Rename to Initiation and Engagement of Substance Use Disorder Treatment
  • Shift from member-based to episode-based
  • Modify Age Stratifications

Follow-Up After Emergency Department visit for Alcohol and Other Drug Abuse or Dependence (FUA)

  • Expanding the denominator to included ED visits due to overdose of drugs with common abuse potential in “any” Dx position
  • Expanding the numerator to allow follow- up visits with SUD indicated in “any” Dx position.
  • Expanding the numerator to include additional follow-up options that do not require a Dx of SUD

Comprehensive Diabetes Care (CDC)

  • Retirement of HbA1c testing sub-measure
  • Creation of three standalone measures for more accurate reporting over time
  • Hemoglobin A1c Control for Patients with Diabetes (HBD)+
  • Eye Exam for Patients with Diabetes (EED)
  • Blood Pressure Control for Patients with Diabetes (BPD)

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.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Contact Healthcare Provider

Complete Data Solution for Healthcare Providers Access Clinical Data with Datavant (formerly known as Ciox)

Contact us

Achieve your boldest ambitions

Explore how Datavant can be your health data logistics partner.

Contact us