What’s Coming for HEDIS MY 2023? Here are the Measure Changes Health Plans Need to Know
Updates include new measures that target access, prevention, utilization, and disease management.
Across the board changes target improving health equity through expanded race and ethnicity data segmentation, more inclusive measure language, and screening and intervention.
The 2023 update also continues to advance digital measure transformation.
The National Committee for Quality Assurance (NCQA) has made an increasing number of HEDIS measure additions, updates, and changes in recent years, and Measurement Year (MY) 2023 is no exception. In summary, for MY 2023, NCQA added five new measures, retired six measures, made major changes to one measure, and made smaller changes across multiple measures. Here we summarize these changes so your quality team can be as prepared as possible for next year’s HEDIS season.
New HEDIS Measures
Before NCQA introduces a new HEDIS measure, it undergoes a rigorous review process that includes input from experts and stakeholders, as well as a public comment period. This ensures that the measure is deemed relevant and feasible for implementation.
The five new HEDIS measures for MY 2023 cover a wide range of specialties, from pediatric dental care to social needs screening and interventions. NCQA summarizes them as follows:
Oral Evaluation, Dental Services (OED) -Medicaid members under 21 years of age who received a comprehensive or periodic oral evaluation with a dental provider.
Purpose: This measure will allow plans to understand if their pediatric members are receiving dental care and to work towards improving access and utilization of dental evaluations.
Topical Fluoride for Children (TFC) - Medicaid members 1-4 years of age who received at least two fluoride varnish applications.
Purpose: This measure will allow plans to understand if their pediatric members are receiving fluoride varnish applications and to promote fluoride varnish treatments for their younger members.
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.
Purpose: This is a deprescribing measure, with the opportunity to promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population.
Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes - 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.
Purpose: Health plans have an opportunity to identify their older patients with diabetes who are at highest risk of hypoglycemia and to implement appropriate interventions to prevent it.
Social Need Screening and Intervention (SNS-E) - Members who were screened, using prespecified instruments, at least once during the measurement period for unmet food, housing and transportation needs, and received a corresponding intervention if they screened positive.
Purpose: NCQA developed this measure as part of an organization-wide effort to advance health equity and encourage health plans to assess and address the food, housing and transportation needs of their patient populations. Health plans can identify specific needs and connect members with the resources necessary to address unmet social needs.
Retired HEDIS Measures
NCQA will typically retire measures that were replaced by newer or broader measures, or measures that have low utility or are burdensome to report, among other things. For Measurement Year 2023, NCQA is retiring the following measures:
Breast Cancer Screening (BCS) - This measure assesses women 50-74 years of age who had at least one mammogram to screen for breast cancer in the past two years. The regular BCS measure is being replaced by the Electronic Clinical Data Systems (ECDS) BSC-E measure, which will be the only of the two measures that's reported going forward.
Annual Dental Visit (ADV) - This measure focused on access to dental care, rather than quality of dental care. This measure was replaced by the Oral Evaluation, Dental Services and Topical Fluoride for Children measures for MY 2023.
Frequency of Selected Procedures (FSP) - This measure summarized the frequency of select clinical procedures. It was found that this measure had low utility and was burdensome for plans to report. The measure’s validity was also questioned due to the number of stratifications that contribute to small sizes for individual reporting categories.
Flu Vaccinations for Adults Ages 18–64 (FVA),Flu Vaccinations for Adults Ages 65 and Older (FVO),Pneumococcal Vaccination Status for Older Adults (PNU) - These CAHPS Health Survey measures have been retired from HEDIS. The expansion of the age range in the Adult Immunization Status measure will ensure that the clinical data regarding vaccination status is captured across all age groups that had been represented in these measures.
Changes to Existing HEDIS Measures
There are currently over 90 HEDIS Measures across six domains of care, including Effectiveness of Care, Access/Availability of Care, Experience of Care, Utilization and Risk Adjusted Utilization, Health Plan Descriptive Information, and Measures Reported Using Electronic Clinical Data Systems (ECDS).
While multiple existing measures feature small changes, the biggest change to an existing HEDIS Measure for MY 2023 is to the Adult Immunization Status (AIS-E). NCQA revised the measure to align with the new pneumococcal vaccination guidelines and added stratifications for age, race, and ethnicity.
Across the Board HEDIS Measure Changes
Several changes NCQA is making effectively cut across measures, including Race/Ethnicity Stratification and Gender Affirming Approaches to Measurement. NCQA has been gradually introducing race and ethnicity stratifications across measures, including Immunizations for Pharmacotherapy for Opioid Use Disorder, Well Child Visits in the First 30 Months of Life, and Breast Cancer Screening, to name a few. Over the next several years, NCQA plans to continue expanding these stratifications across more HEDIS measures to help identify disparities in care among patient populations.
NCQA has also revised measures which reference pregnancy or delivery to remove limitation to women and to appropriately acknowledge member gender identity. Going forward, NCQA plans to pursue additional opportunities to make HEDIS measures more inclusive of sexual and gender minority members.
Health Plans Benefit from Working with a HEDIS Certified Vendor
With NCQA releasing new measures and measure changes every year, it’s more important than ever that health plans ensure their quality measurement data is accurate and timely. By working with a quality-measure reporting software vendor that is NCQA Certified, payers can be confident that they’re getting the most accurate and rigorously tested quality measurement solution in the industry.
Vital Data Technology is proud to be one of a select group of quality-measure software vendors in the country with full HEDIS and AMP Certification from NCQA. OurAffinitē Quality Improvement (QI) solution has received HEDIS Certification from NCQA going on 11 consecutive years with no re-certifications, and we are certified for all NCQA IHAAMP measures, ensuring that Affinitē QI ranks among the top third-party vendor platforms in California.
Vital Data Technology is transforming the healthcare ecosystem by empowering healthcare stakeholders with prescriptive insights to improve member health and lower costs. Vital Data Technology leverages embedded, real-time data science, Ai, and analytics together to drive intelligent automation through their cloud-based Affinitē platform.