The revisions span multiple populations and conditions while addressing social determinants.
As the National Committee for Quality Assurance (NCQA) advances digital quality measurement (dQM), it will continue publishing its print-based measures manual—the Healthcare Effectiveness Data and Information Set (HEDIS)—which has just been updated for 2023.
NCQA made 14 updates spanning measure additions, reductions, and more.
New HEDIS measures
The following first-time metric names and descriptions are quoted verbatim for full accuracy:
- Oral Evaluation, Dental Services (OED). Medicaid members under 21 years of age who received a comprehensive or periodic oral evaluation with a dental provider.
- Topical Fluoride for Children (TFC). Medicaid members 1-4 years of age who received at least two fluoride varnish applications.
- Deprescribing of Benzodiazepines in Older Adults (DBO). Medicare members 67 years of age and older who were dispensed benzodiazepines who achieved a ≥20% decrease reduction in benzodiazepine dose.
- Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes (EDH). For Medicare members 67 years of age and older with diabetes (types 1 and 2), the risk-adjusted ratio of observed to expected emergency department (ED) visits for hypoglycemia.
NCQA increases focus on social determinant screening, intervention, and data
The agency added a fifth new measure, name and description:
- Social Need Screening and Intervention (SNS-E). Members who were screened, using prespecified instruments, at least once during the measurement … and received a corresponding intervention if they screened positive.
Screening is a growing focus of health equity efforts. The NCQA has prioritized food, housing, and transportation for the new SNS-E measure, with a corresponding focus on intervention with one month of need identification.
The agency has also added race and ethnicity stratifications to eight more HEDIS metrics:
Immunizations for Adolescents, Asthma Medication Ratio, Follow-Up After Emergency Department Visit for Substance Use, Pharmacotherapy for Opioid Use Disorder, Initiation and Engagement of Substance Use Disorder Treatment, Well-Child Visits in the First 30 Months of Life, Breast Cancer Screening, and Adult Immunization Status.
The NCQA states that it "plans to continue expanding the race and ethnicity stratifications to HEDIS measures over the next several years to help identify disparities in care among patient populations."
Additional updates for gender affirmation
The NCQA states that it will "explore additional opportunities to transform HEDIS measures to be more inclusive and affirming of sexual and gender minority members." In its 2023 measures update, this included an update that "pregnancy and childbirth are not experienced exclusively by individuals who identify as women [to] … reduce the likelihood of transgender members are inadvertently excluded or inappropriately included in a measure due to gender identity."
Retired HEDIS measure
The agency has retired the following metrics, names and descriptions:
- Annual Dental Visit (ADV): This measure focused on access to dental care, rather than quality of dental care.
- Frequency of Selected Procedures (FSP)
- Flu Vaccinations for Adults Ages 18–64 (FVA), Flu Vaccinations for Adults Ages 65 and Older (FVO), Pneumococcal Vaccination Status for Older Adults (PNU)
Measure requirements and reporting updates
The NCQA will continue promoting existing measure digitization—i.e., Electronic Clinical Data Systems (ECDS) reporting—during the multi-year transition to dQM, an approach that will be more automated and comprehensive.
Two 2023 changes focus on women's health. Voluntary ECDS will be permitted for the Cervical Cancer Screening measure while electronic reporting will now be required for Breast Cancer Screening.
A broader change to support digital measures will make optional measures exclusions required.
Laura Beerman is a contributing writer for HealthLeaders.
The 14 updates include new measures that target access, prevention, utilization, and disease management.
Other changes target improving health equity through screening, intervention, expanded race and ethnicity data segmentation, and more inclusive measure language.
The 2023 update also advances digital measure transformation.