Keeping Up to Date on HEDIS Quality Measure Changes for 2018

Keeping Up to Date on HEDIS Quality Measure Changes for 2018

Every year, the National Committee for Quality Assurance (NCQA) releases a new edition of the technical specs for the Healthcare Effectiveness Data and Information Set (HEDIS). This tool is used to assess and improve performance.

In 2018, the NCQA added seven new measures and made adjustments to two existing quality measures. The following are the additions made to the 2018 HEDIS:

Transitions of Care

This new measure analyzes the percentage of inpatient discharges for Medicare members over 18 years of age that had each of the following during the measurement year:

  • Notification of Inpatient Admission
  • Receipt of Discharge Information
  • Patient Engagement After Inpatient Discharge
  • Medication Reconciliation Post-Discharge

This measure is intended to improve care coordination during transitions for those that fall into the at-risk population. This includes older adults as well as individuals with more complex than normal health needs.

Use of Opioids at High Dosage

This measure looks at health plan members that are 18 years or older that receive long-term opioids at high dosage. An average morphine equivalent dose is greater than 120mg

Use of Opioids from Multiple Providers

This measure is intended to look at high dosage, multiple prescribers and pharmacies that as risk factors for dangerous overdose and death. It is important to consider these stats when battling the opioid epidemic. The measure assesses the rate of health plan members 18 years and older who receive opioids from multiple pharmacies or prescribers.

Pneumococcal Vaccination Coverage for Older Adults

This new measure uses electronic data, and is intended to eventually supplant the current survey-based metric. It assesses the percentage of health plan members over the age of 65 years that received the series of pneumococcal vaccines.

Follow-Up After Emergency Department Visit for People With High-Risk Multiple Chronic Conditions

This measure assesses the percentage of emergency department visits for Medicare members over the age of 18 years that also have high-risk multiple chronic conditions and follow-up care within 7 days. It is intended to improve the coordination of care for Medicare beneficiaries with multiple chronic conditions who are sent home from the Emergency Room.

Unhealthy Alcohol Use Screening and Follow-Up

This measure looks at health plan members 18+ years screened for unhealthy alcohol use. If they screen positive, it analyzes whether they received appropriate follow-up care within a two month time period.

Depression Screening and Follow-Up for Adolescents and Adults

This measure assesses health plan members over the age of 12 years that were screened for clinical depression. If they screened positive, it analyses whether or not they received appropriate follow-up care.

If keeping up with these changes is too difficult, HEDIS Nurses can help!

At HEDIS Nurses, it’s our job to stay up to date with the annual changes and additions that are made to the HEDIS Quality Measures. Our qualified team of nurses pay close attention to changes and how these impact your business. Instead of getting frustrate over keeping track of these yourself, let us help! Call (877) 328-2343 today to get started.