Introduction to HEDIS Part 1

Introduction to HEDIS

Qsource Training Module Part 1

6. Review the different types of data and ways HEDIS data can be used

5. Discuss medical record review tips

1. Identify how a HEDIS measure is developed

4. Discuss implementing HEDIS data collection and reporting

3. Review the Administrative and Hybrid Data Collection Methods and Sampling Guidelines

2. Summarize the HEDIS Compliance audit process and how to submit data

Training Objectives

• The background of National Committee for Quality Assurance (NCQA), the organization responsible for developing HEDIS measures.
• How HEDIS measures are developed and categorized.

In this session we will discuss the following:

What is NCQA?

National Committee for Quality Assurance

The NCQA is a private, nonprofit healthcare quality oversight organization that measures and reports on healthcare quality. NCQA's Mission: To improve the quality of healthcare. MCQA's Vision: To transform healthcare through measurement, transparency and accountability

What is NCQA?

Using NCQA Health Plan Accreditation (HPA) to Ensure Quality

12 states use the results of the accreditation process to satisfy federal oversight requirements

12

7 states accept NCQA's Health Plan Accreditation as meeting broad accreditation requirements

27

27 states require that health plans serving their Medicaid population be accredited by NCQA

Acknowledge health plans that have gone through the NCQA accreditation process

Demonstrate their commitment to maximizing limited oversight resources

Reallocate resources to priority projects

Simplify administrative review efforts

When states use the results of the accreditation process to satisfy federal oversight requirements this is called non-duplication, or "deeming. Invoking Medicaid's "non-duplication" provisions allows states to:

Using NCQA Health Plan Accreditation (HPA) to Ensure Quality

• HEDIS (Commercial)
• HPA (Commercial and Medicaid)
• Patient Centered Medical Home (PCMH)
• LTSS (Medicaid)
• HEA (Medicaid

• HEDIS (Commercial)
• HPA (Commercial and Medicaid)

• HEDIS (Commercial)
• HPA (Commercial and Medicaid)
• Patient Centered Medical Home (PCMH)

• HPA (Commercial)

Tennessee

Indiana

Florida

Arkansas

NCQA programs are used across the country to assist states in delivering quality care and holding providers accountable. Each state takes a unique approach to the process.

Qsource States Using NCQA Programs

What is HEDIS?

What is HEDIS?

HEDIS measures are the most widely used set of standardized performance measures in managed care

HEDIS stands for Healthcare Effectiveness Data and Information Set

Of the nation's health insurance organizations, employers, and regulators use HEDIS measures

90%

NCQA publishes 7 HEDIS volumes that specify how organizations collect, audit, and report HEDIS measures

• Volume 1 - Overview and Background
• Volume 2 - Technical Specifications (non-survey measures)
• Volume 3 - Survey Measures (CAHPS)
• Volume 5 - HEDIS Compliance Audit
• Volume 6 - Health Outcomes Study (HOS)
• HEDIS Technical Specifications for LTSS Measures

HEDIS Publications

How are HEDIS Measures Developed?

Desirable Attributes

Feasibility

Scientific Soundness

Relevance

Who Decides on HEDIS?

Technical Measurement Advisory Panel

Committee on Performance Measurement (CPM)

NCQA Board of Directors

First Year

Step 4

Retirement

Public Comment

step 7

step 3

Evaluation

Development

step 6

Step 2

Public Reporting

Selection

Step 1

step 5

HEDIS Measure Life Cycle

What Goes Into HEDIS?

• The traditional schedule released measure specifications halfway through the year.
• For example, measures released in July 2019 apply to services provided for the entire calendar year, January 1st to December 31st 2019.
• This means that the measurement year is half over before plans know what they are expected to report.
• This six-month delay has been a part of the HEDIS cycle for decades.

HEDIS Publication Timeline Change

Plans now have a 5-month advance notice on measures

Report HEDIS results for 2022 period

JUN

DEC

JAN

Measures apply to the 2022 period

DEC

JAN

August 1 New HEDIS measures are released

2023

2022

DEC

AUG

JAN

2021

The new publication schedule looks like this:

HEDIS Publication Timeline Change

Volume 2 Technical Specifications for Health Plans Short Name: HEDIS MY 2022 Volume 2

New Naming Convention

Volume 2 Technical Specifications for Health Plans Short Name: HEDIS 2023 Volume 2

Old Naming Convention

JUN

DEC

JAN

DEC

JAN

DEC

AUG

Traditionally, a HEDIS publication has been named for the year the data is reported, and not the year services were provided. In 2020, HEDIS volumes were renamed based on the measurement year.

HEDIS Publication Naming Change

Congratulations!

You have completed Introduction to HEDIS Part 1

mhoover@qsource.org

Contact Michelle Hoover, EQRO Division Team Trainer if you have any questions about this lesson.