HEDIS Updates to quality ratings, measures & reporting. Wilhelmina Delostrinos, Director of Quality Improvement & Accreditation

Transcription

1 HEDIS 2018 Updates to quality ratings, measures & reporting Wilhelmina Delostrinos, Director of Quality Improvement & Accreditation

2 Agenda HEDIS Overview HEDIS 2018 Changes to Existing Measures HEDIS 2018 First-Year Measures Annual HEDIS Submission Process & Timeline WA State 2017 Quality Ratings 2

3 HEDIS Overview Health Effectiveness Data and Information Set (HEDIS) is a set of performance measures utilized by more than 90% of America s health plans to measure performance on important dimensions of care and service Effectiveness of Care 55 MEASURES Access/Availability of Care 6 MEASURES Quality of clinical care (Examples: Controlling hypertension, cervical cancer screening) Member s access to basic health plan services (Examples: Prenatal & postpartum care) Administered by the National Committee on Quality Assurance (NCQA), a non-profit organization dedicated to improving health care quality NCQA s Committee on Performance Measurement (CPM), which includes representation from purchasers, consumers, health plans, health care providers and policy makers, oversees the evolution of the measurement set. 6 DOMAINS of CARE Experience of Care *VARIES* Utilization & Risk Adjusted Utilization 16 MEASURES Member s experience with the health plan and its contracted providers (Examples: CAHPS survey questions such as rating of provider) Measures health plan utilization (Examples: Well-child visits, ED visits per 1,000, total hip replacements) Methodology to collect and calculate the data is standardized, which allows consumers, employers, government agencies, and other health plans themselves to more accurately compare and evaluate performance amongst plans Health Plan Descriptive Information 6 MEASURES Measures Collected Using Electronic Data Systems 5 MEASURES Information about health plan (Examples: Board certification, total membership) Measures requiring structured electronic clinical data to be shared between clinicians and plans for automated quality reporting (Examples: Utilization of PHQ-9 to monitor depression) 84 TOTAL MEASURES (NOT INCLUDING EXPERIENCE OF CARE) 3

4 HEDIS Measure Cycle All HEDIS measures are reviewed annually after the HEDIS submission season by NCQA s Committee on Performance Measurement (CPM) for evaluation as to whether the measure is still of value to consumers, purchasers, health plans, and providers and is in alignment with clinical and healthcare industry standards. The CPM also meet regularly to develop new measures based on new clinical guidelines or healthcare industry criteria and will suggest them for voluntary first-year reporting. First-Year Measures Voluntary reporting for Year 1 Evaluation of results Adopt as official measure OR Revise specifications Existing Measures Mandatory reporting for Year 2+ Evaluation of results No change OR Revise specifications OR Retire measure 4

5 Revisions to Existing HEDIS Measures for 2018 MEASURES: Immunizations for Adolescents (IMA) Breast Cancer Screening (BCS) Medication Management for People With Asthma (MMA) Asthma Medication Ratio (AMR) Medication Reconciliation Post-Discharge (MRP) Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET) Depression Remission or Response for Adolescents and Adults (DRR) DESCRIPTION OF CHANGE: Added a two-dose HPV vaccination series Added digital breast tomosynthesis as a method for screening Removed Medicare reporting Removed commercial reporting for the age group Removed Medicare reporting Removed commercial reporting for the age group Clarified that the current medication list must be documented in the outpatient medical record Added dispensing of medication-assisted treatment Added telehealth to the denominator and numerators Extended the Engagement of AOD Treatment time frame to 34 days from 30 days Expanded the depression follow-up period to 4 8 months and revised the time frame for the criteria that define the initial population, including the age criteria, continuous enrollment, allowable gap, and intake period. 5

6 First-Year HEDIS Measures for 2018 TRANSITIONS OF CARE (TRC) The percentage of discharges for members 18 years of age and older who had each of the following during the measurement year. Four rates are reported: 1. Notification of Inpatient Admission. Documentation of receipt of notification of inpatient admission on the day of admission or the following day. 2. Receipt of Discharge Information. Documentation of receipt of discharge information on the day of discharge or the following day. 3. Patient Engagement After Inpatient Discharge. Documentation of patient engagement (e.g., office visits, visits to the home, telehealth) provided within 30 days after discharge. 4. Medication Reconciliation Post-Discharge. Documentation of medication reconciliation on the date of discharge through 30 days after discharge (31 total days). 6

7 First-Year HEDIS Measures for 2018 DEPRESSION SCREENING AND FOLLOW-UP FOR ADOLESCENTS AND ADULTS (DSF) The percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care. 1. Depression Screening. The percentage of members who were screened for clinical depression using a standardized tool. 2. Follow-Up on Positive Screen. The percentage of members who screened positive for depression and received follow-up care within 30 days. Escribers and Multiple Pharmacies rates). UNHEALTHY ALCOHOL USE SCREENING AND FOLLOW-UP (ASF) The percentage of members 18 years of age and older who were screened for unhealthy alcohol use using a standardized tool and, if screened positive, received appropriate follow-up care. 1. Unhealthy Alcohol Use Screening. The percentage of members who had a systematic screening for unhealthy alcohol use. 2. Counseling or Other Follow-up. The percentage of members who screened positive for unhealthy alcohol use and received brief counseling or other follow-up care within 2 months of a positive screening. 7

8 First-Year HEDIS Measures for 2018 USE OF OPIOIDS AT HIGH DOSAGE (UOD) For members 18 years and older, the rate per 1,000 receiving prescription opioids for 15 days during the measurement year at a high dosage (average morphine equivalent dose [MED] >120 mg). USE OF OPIOIDS FROM MULTIPLE PROVIDERS (UOP) For members 18 years and older, the rate per 1,000 receiving prescription opioids for 15 days during the measurement year who received opioids from multiple providers. Three rates are reported: 1. Multiple Prescribers. The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers during the measurement year. 2. Multiple Pharmacies. The rate per 1,000 of members receiving prescriptions for opioids from four or more different pharmacies during the measurement year. 3. Multiple Prescribers and Multiple Pharmacies. The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers and four or more different pharmacies during the measurement year (i.e., the rate per 1,000 of members who are numerator compliant for both the Multiple Prescribers and Multiple Pharmacies rates). 8

9 First-Year HEDIS Measures for 2018 FOLLOW-UP AFTER EMERGENCY DEPARTMENT VISIT FOR PEOPLE WITH HIGH-RISK MULTIPLE CHRONIC CONDITIONS (FMC) The percentage of emergency department (ED) visits for members 18 years and older who have high-risk multiple chronic conditions who had a follow-up service within 7 days of the ED visit. PNEUMOCOCCAL VACCINATION COVERAGE FOR OLDER ADULTS (PVC) The percentage of members 65 years of age and older who have received the recommended series of pneumococcal vaccines: 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23). 9

10 HEDIS 2018 Measure Trends Telehealth NCQA now allows plans to accept telehealth modifiers and telephone visits for the following measures: FUH, FUM, FUA, LBP, ADD, IET, IAD, & MPT Electronic Clinical Data Systems (ECDS) Measures Continued redevelopment and testing of new ECDS measures Align with new CMS Quality Payment Program reporting (MIPS/APM) requiring electronic reporting of data Electronic data systems include EHRs, immunization & other clinical registries, electronic databases, etc. 10

11 HEDIS 2018 Submission Season The Annual HEDIS Submission Season is a retrospective review of quality performance that is submitted to NCQA and CMS for external reporting once a year. This season begins in November and ends in June and will be capturing data primarily for services that occurred in Administrative & Supplemental Data NOV JAN 2017 Official HEDIS/CAHPS Results Released AUG-OCT 2018 HEDIS Compliance Audit: On-Site Visit FEB-MAR 2018 Final Submission to NCQA JUN 2018 Hybrid Medical Record Review JAN MAY 2018 HEDIS Compliance Audit: MRRV MAY

12 NCQA Health Insurance Plan Ratings 2017 WA State Commercial Plan Results Source: 12

13 NCQA Health Insurance Plan Ratings 2017 WA State Medicare Plan Results Source: 13

14 Washington Healthplanfinder WA State Marketplace Plan Results Insurance Company Washington Healthplanfinder Quality Rating* BridgeSpan (EPO) Too new to rate. Coordinated Care (HMO) Kaiser of Washington (HMO) NW Kaiser Foundation Healthplan of WA the Northwest LifeWise (EPO) Too new to rate. Molina (HMO) Premera Blue Cross (EPO) Too new to rate. Source: 14

15 WHA 2017 Community Checkup WA State Medical Group Results: Commercial Population Source: 15

16 WHA 2017 Community Checkup WA State Medical Group Results: Medicaid Population Source: 16

17 QUESTIONS? 17