Introduction to HEDIS Part 1

Introduction to HEDIS

Qsource Training Module Part 1

Training Objectives

1. Identify how a HEDIS measure is developed

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

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

4. Discuss implementing HEDIS data collection and reporting

5. Discuss medical record review tips

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

In this session we will discuss the following:

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

What is NCQA?

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

Using NCQA Health Plan Accreditation (HPA) to Ensure Quality

27

12

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

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

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

Using NCQA Health Plan Accreditation (HPA) to Ensure Quality

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:

Reallocate resources to priority projects

Simplify administrative review efforts

Demonstrate their commitment to maximizing limited oversight resources

Acknowledge health plans that have gone through the NCQA accreditation process

Qsource States Using NCQA Programs

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.

Arkansas

Florida

Tennessee

Indiana

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

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

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

• HPA (Commercial)

What is HEDIS?

What is HEDIS?

90%

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

HEDIS stands for Healthcare Effectiveness Data and Information Set

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

HEDIS Publications

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

How are HEDIS Measures Developed?

Desirable Attributes

Scientific Soundness

Relevance

Feasibility

Who Decides on HEDIS?

Committee on Performance Measurement (CPM)

NCQA Board of Directors

Technical Measurement Advisory Panel

HEDIS Measure Life Cycle

Selection

Step 1

step 3

Public Comment

Development

Step 2

Public Reporting

step 5

Step 4

Evaluation

step 6

step 7

Retirement

First Year

What Goes Into HEDIS?

HEDIS Publication Timeline Change

• 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

The new publication schedule looks like this:

2021

2022

2023

DEC

DEC

JUN

JAN

DEC

JAN

JAN

AUG

Measures apply to the 2022 period

August 1 New HEDIS measures are released

Report HEDIS results for 2022 period

Plans now have a 5-month advance notice on measures

HEDIS Publication Naming Change

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.

Old Naming Convention

New Naming Convention

DEC

DEC

JUN

JAN

DEC

JAN

AUG

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

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

Congratulations!

You have completed Introduction to HEDIS Part 1

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

mhoover@qsource.org