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NCQA & Upcoming HEDIS Changes Effective July 1, 2020

NCQA & Upcoming HEDIS Changes

The National Committee for Quality Assurance (NCQA) will be releasing new updates on 7/1/2020. Historically, health plans reporting HEDIS data receive guidelines 6 -7 months after the start of data collection, unfortunately, half of the reporting year is over before the plans ultimately know what information needs to collected. This process has been an ongoing problem, especially since most members have their Annual Wellness Visits (which includes preventive care) during the first half of the year.

Another recurring issue has been the confusion surrounding Reporting Year and Measurement Year. Reporting Year 2020 is collecting data for Measurement Year 2019. Explaining this process creates added confusion, especially for any individual that is new to the requirements surrounding HEDIS.

NCQA has heard the public and these long-standing, non-sensical procedures will be abolished in the release on 7/1/2020. In a recent webinar, Peggy O’Kane, Founder and CEO of NCQA, stated, “We are changing the HEDIS schedule. We are changing when we specify measures that apply to a measurement period. Our traditional schedule is to release measure guidelines with HEDIS Volume 2 – HEDIS Technical Specifications halfway through the year. The measurement year was half over before plans knew what they’re expected to report.”

What’s Changing at NCQA

On July 1, 2020, NCQA will publish Technical Specifications that will apply to Measurement Years 2020 and 2021. These game-changing updates will help improve data compliance by providing guideline requirements prior to the start of the year. In this new NCQA schedule, plans will have a 5-month lead time on new HEDIS measures, insights into what measures have been retired and any changes to existing measures.

Please Note - Reporting all HEDIS data will still happen in June, this will not change.

While shifting the HEDIS schedule, NCQA will also simplify the naming convention starting in calendar year 2020. The HEDIS Reporting Year will be named the same as the Measurement Year.

Mark your calendar for August 1, 2021, as NCQA will release an update including any new measures and changes to existing measures. These changes will apply to services in 2022 – not 2021.

How You Gather Your Data

In October of 2019, there were eight digital measures released, these are machine readable and downloadable from the NCQA store. NCQA digitalized these measures to help streamline how your gather your data. Yearly, numerous programming hours are spent translating the NCQA PDF version of Volume 2 – HEDIS Technical Specifications into computer code – upwards of 50-plus hours per measure. NCQA anticipates the use of digitalized versions of existing HEDIS measures will save time and help avoid human error. Be sure to join the Digital Measurement Community at NCQA.com for more information.

“The HEDIS hybrid method uses administrative data, but also requires a sample of medical records be reviewed for information that we would not ordinarily find in claims data. This method is manual, retrospective and burdensome. We would like to move away from this method. We are really trying to shift quality measurement to be much more prospective,” said Michael Barr, Executive VP of NCQA.

Common Questions Asked Regarding NCQA

Q. Will all HEDIS measures eventually be written in digital format? Is that the future?

  • “I think the answer is likely that not all the measures will be digitalized, because some of them will be difficult to digitalize. We are working through a prioritization scale to digitize those existing measures in the traditional reporting that could be, and then should be, translated to digitalized format.” - Michael Barr - Executive VP of NCQA

Q. Where can I find more information about digital measures?

What Can Vee Technologies Provide Your Organization?

Vee Technologies possesses the knowledge and capability to help guide your organization through HEDIS measures. Combining our insightful analytics with seasoned professional reviewers will ensure optimal Quality Scores and Star Ratings.

Contact us today for a custom HEDIS Quality Review program.

NCQA HEDIS Certification in progress to also report all administrative measures.

 

Rhonda McElvany, RN, CRC - Quality Programs Director

Silas Goldman - Senior Director of Operations This email address is being protected from spambots. You need JavaScript enabled to view it.