HEDIS Expansion of Digital Measures: Preparing for 2022 Reporting

In 2015, the National Committee for Quality Assurance (NCQA) initiated a multi-year process to transform Healthcare Effectiveness Data and Information Set (HEDIS®) quality measurement, beginning with the specification of the first Electronic Clinical Data Systems (ECDS) measure. ECDS measures are a subset of measures that NCQA specifies in a digital measure format[1] that represent a new reporting method leveraging clinical data available at the point of care. 

Digital measures are intended to make measure specifications easier to work with, and continue to be a key theme for NCQA. In November 2020, NCQA provided five draft measures that specified using Fast Healthcare Interoperability Resource Clinical Quality Language (FHIR CQL) as a preview to stakeholders. FHIR CQL is a measure-authoring standard that aligns with CMS and other industry quality measure programs, and utilizes the FHIR data model standard maintained by Health Level Seven International (HL7). NCQA intends to release the first set of FHIR CQL HEDIS measures for Measurement Year 2022 for reporting in June 2023. [2]

Changes towards digital

NCQA has indicated that transitioning to digital measures is a significant priority for HEDIS measurement, so it’s important that plans understand and begin preparing for the digital future of HEDIS. As a reference, we’ve updated our annual HEDIS timeline for download to track planning, milestones, and deadlines as the year progresses for MY2021 measure submission.

Measurement Year 2020 and 2021 specifications included eight digitized versions of existing measures reported using the traditional method, and 11 measures specified using the ECDS format.[3] Upcoming changes include the NCQA proposal to release a number of additional digital measures for Measurement Year 2022. Specifications for the following measures are anticipated in August 2021.

Additionally, NCQA has indicated Cervical Cancer Screening may be eligible for ECDS reporting beginning in MY2023.[12]

Taking a gradual approach to the rollout of digital measures, NCQA is involving stakeholders, analyzing results and encouraging dual reporting. Please read our earlier blog HEDIS: Public Reporting is the next phase for ECDS to learn about the first measure to be publicly reported based on the ECDS methodology.

Understanding the impact for health plans: the Colorectal Cancer Screening (COL) Example

Let’s use the Colorectal Cancer Screening (COL) measure as a practical example of what this means to health plans. The ECDS specification for COL was introduced with Measurement Year 2019. Plans can optionally report the COL measure using the ECDS specification alongside their traditional reporting utilizing the administrative or hybrid specifications. NCQA proposes to continue this optional dual reporting through Measurement Year 2022. For Measurement Year 2023, plans would be expected to choose one method of measure specification for HEDIS submission with the expectation that the traditional specifications would not be supported in Measurement Year 2024[13]^, [14]. 

In general, this timeline provides plans with five years between the initial measure specification and conversion to the ECDS method. For the two measures that have only an administrative specification—Breast Cancer Screening (BCS) and Follow-Up Care for Children prescribed ADHD medication (ADD)—the proposed timeline is four years for transition. 

The removal of traditional reporting for COL may have a significant impact to plans that currently rely heavily on medical record review for the hybrid methodology. There are steps plans can take now to ensure readiness for the transition to digital measures

1. Identify supplemental data sources. The removal of a hybrid reporting option will reduce reliance on costly medical record review, but supplemental sources may be required to maintain plan performance throughout this transition. Note that the proposed digital measures also include Childhood Immunization Status (CIS), Immunizations for Adolescents (IMA) and Cervical Cancer Screening (CCS), which currently support the hybrid methodology. The proposed timeline to remove hybrid reporting for COL by MY2024 as we mentioned earlier, could imply that the hybrid methodology option for these two measures may be treated similarly.
2. Review provider contracts. The COL measure, in particular, is challenging due to the 10-year history required to identify prior colonoscopies. In many cases, your health plan may not have paid for the service rendered, but it can still count towards numerator compliance. Now is a great time to review provider contracts to ensure the provision of member data is a requirement, regardless of the payor of the service. 
3. Get familiar with the FHIR data model. There is a great deal of similarity in terminology between the current administrative and hybrid specifications compared to the digital measure specifications; however, there may be meaningful differences in terminology due to the use of the FHIR data model. For example, the use of pharmacy claims may imply medications dispensed, but the FHIR data model was built for clinical data where there is an important and explicit distinction between medications prescribed and medications dispensed.

NCQA has indicated that HEDIS is evolving to focus on quality improvement over quality measurement. The process of updating measures to take advantage of delivery system capabilities and the new digital future is underway.[15]

As NCQA measures and timelines evolve, having a trusted partner who knows and understands the complexities of HEDIS is more important than ever. SS&C Health will continue to provide expert annual guidance and information to assist plans on the HEDIS journey. Contact us today for a demo of our SS&C® CareAnalyzer platform, which is fully certified under the NCQA HEDIS Health Plan and Allowable Adjustments Measure Certification^SM program, including all Electronic Clinical Data Systems (ECDS) measures.