Changes to HEDIS reflect focus on health equity

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The nonprofit National Committee for Quality Assurance has revised the health plan quality measures in the Health Care Efficiency Data and Information Set (HEDIS) for the year of measurement 2023. The NCQA added racial/ethnic stratifications and made revisions to recognize and affirm members’ gender identity.

Collecting race and ethnicity data is key to improving health disparities, the NCQA said. Greater transparency of health plan performance by race and ethnicity will help illuminate and investigate gaps in care and inequitable care so the industry can learn from the best. To identify and reduce disparities in care, the NCQA added racial and ethnic stratifications to eight HEDIS measures.

To ensure HEDIS metrics recognize and affirm members’ gender identity, the NCQA has revised metrics that reference pregnancy or childbirth to remove the limitation to women. This change recognizes that pregnancy and childbirth are not experienced exclusively by people who identify as female, the NCQA said, and will reduce the likelihood of transgender members being inadvertently excluded or inappropriately included in a extent because of their gender identity. The NCQA intends to explore other ways to make the measures inclusive and affirming of members of sexual and gender minorities.

Another measure concerns social needs screening and intervention (SNS-E). To encourage health plans to assess and meet the food, housing, and transportation needs of their patient populations, this measure helps health plans identify specific needs and connect members to the resources needed to meet the needs. social unsatisfied. This measure assesses members who were screened, using pre-defined instruments, at least once during the measurement period for unmet food, housing, and transportation needs, and who received a corresponding intervention. if they were positive.

Other measures have been added to address pediatric dental care, safety and appropriateness, and diabetes care:

Oral Evaluation Dental Services (OED). Good oral health is essential to a child’s overall health, and oral examinations are important for preventing disease, reversing disease processes, preventing the progression of cavities and reducing the incidence of future lesions. This measure will help plans understand whether their pediatric Medicaid members (under the age of 21) are receiving comprehensive or periodic oral assessments with a dental provider and help improve access and utilization of dental services for members. .

Topical fluoride for children (TFC). Dental cavities are the most common chronic disease among children in the United States. Topical fluoride plays an important role in the prevention of tooth decay. This measure will help plans understand if their pediatric Medicaid members, ages 1-4, are receiving at least two fluoride varnish applications and help promote fluoride varnish treatments for younger members.

Deprescribing benzodiazepines in the elderly (BOD). The 2019 American Geriatrics Society Beers Criteria recommends avoiding benzodiazepines in older adults. Clinical guidelines recommend deprescribing benzodiazepines slowly and safely, rather than stopping use immediately, to minimize withdrawal symptoms and improve patient outcomes. This measure assesses Medicare members age 67 and older who received benzodiazepines and achieved a ≥20% reduction in benzodiazepine dose. This deprescribing measure provides an opportunity to promote harm reduction by assessing the appropriate reduction in benzodiazepine use.

Emergency room visits for hypoglycemia in older people with diabetes (EDH). Older people are more likely to suffer from severe hypoglycemia (low blood sugar), leading to falls and fractures, increased risk of cardiovascular events and cognitive decline. Clinical practice guidelines for the treatment of older adults with diabetes emphasize prevention of hypoglycemia and encourage avoidance of intensive glycemic control. Health plans have the ability to identify their elderly patients with diabetes (types 1 and 2) and measure the risk-adjusted ratio between observed and predicted emergency department visits for those at highest risk of diabetes. hypoglycemia, and to implement appropriate interventions for prevention.

“All of us at the NCQA are committed to advancing health equity, starting with how we measure quality outcomes,” NCQA President Margaret E. O’Kane said in a statement. “I thank the many people and groups who work with us and offer insightful advice to help us evolve HEDIS to ensure that this important quality improvement tool helps people from all walks of life.”

In addition, five HEDIS measures have been removed and others have undergone modest changes. HEDIS 2023 also marks NCQA’s continued transition to Electronic Clinical Data Systems (ECDS) reporting, ensuring that diverse clinical data sources inform quality measurement and quality improvement.

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