HEDIS Changes Reflect Focus on Health Equity | Healthcare Innovation

The nonprofit National Committee for Quality Assurance has revised quality measures for health plans in the Healthcare Effectiveness Data and Information Set (HEDIS) for measurement year 2023. NCQA has added race/ethnicity stratifications and made revisions to acknowledge and affirm member gender identity.

Collecting race and ethnicity data is key to improving health disparities, NCQA said. Better transparency into health plan performance by race and ethnicity will aid the illumination and investigation of care gaps and inequitable care so that the industry can learn from top performers. To identify and reduce disparities in care, NCQA has added race and ethnicity stratifications to eight HEDIS measures.

To ensure that HEDIS measures acknowledge and affirm members’ gender identity, NCQA has revised measures that reference pregnancy or deliveries to remove the limitation to women. This change acknowledges that pregnancy and childbirth are not experienced exclusively by individuals who identify as women, NCQA said, and will reduce the likelihood that transgender members are inadvertently excluded or inappropriately included in a measure due to gender identity. NCQA intends to explore other ways to make measures inclusive and affirming of sexual and gender minority members.

Another measure addresses Social Need Screening and Intervention (SNS-E). To encourage health plans to assess and address the food, housing and transportation needs of their patient populations, this measure helps health plans identify specific needs and connect members with resources necessary to address unmet social needs. This measure assesses members who were screened, using prespecified instruments, at least once during the measurement period for unmet food, housing, and transportation needs, and who received a corresponding intervention if they screened positive.

Other measures have been added to address pediatric dental care, safety and appropriateness, and diabetic care:

Oral Evaluation Dental Services (OED). Good oral health is vital to a child’s overall health, and oral examinations are important to prevent disease, reverse disease processes, prevent the progression of cavities and reduce the incidence of future lesions. This measure will help plans understand if their pediatric Medicaid members (under 21 years of age) receive comprehensive or periodic oral evaluations with a dental provider and will help improve access and utilization of dental services for members.

Topical Fluoride for Children (TFC). Dental cavities are the most common chronic disease in children in the United States. Topical fluoride plays an important role in preventing tooth decay. This measure will help plans understand if their pediatric Medicaid members, who are 1-4 years of age, receive at least two fluoride varnish applications and will help promote fluoride varnish treatments for younger members.

Deprescribing of Benzodiazepines in Older Adults (DBO). The 2019 American Geriatrics Society Beers Criteria recommends that benzodiazepines be avoided in older adults. Clinical guidelines recommend deprescribing benzodiazepines slowly and safely, rather than stopping use immediately, to minimize withdrawal symptoms and improve patient outcomes. This measure assesses Medicare members 67 years of age and older who were dispensed benzodiazepines and who achieved a ≥20% decrease reduction in benzodiazepine dose. This deprescribing measure presents an opportunity to promote harm reduction by assessing appropriate tapering of benzodiazepine use.

Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes (EDH). Older adults are more likely to experience severe hypoglycemia (low blood sugar), leading to fall-related events and fractures, increased risk of cardiovascular events and cognitive decline. Clinical practice guidelines for the treatment of older adults with diabetes emphasize the prevention of hypoglycemia and encourage avoidance of intensive glycemic control. Health plans have an opportunity to identify their older patients with diabetes (types 1 and 2) and measure the risk-adjusted ratio of observed to expected emergency department visits for those who are at the highest risk of hypoglycemia, and to implement appropriate interventions for prevention.

“All of us at NCQA are committed to advancing health equity, starting with how we measure quality results,” said NCQA President Margaret E. O’Kane, in a statement. “I thank the many people and groups who work with us and offer thoughtful guidance to help us evolve HEDIS to ensure that this important quality improvement tool helps people of all backgrounds.” 

Additionally, five HEDIS measures have been retired and others received modest changes. HEDIS 2023 also marks NCQA’s continued transition to Electronic Clinical Data Systems (ECDS) reporting, ensuring diverse clinical data sources inform quality measurement and quality improvement.