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March 27, 2018

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New and Updated HEDIS Measures Address Opioid, Alcohol Use

July 27, 2017:

Several of the new and updated measures in the 2018 update of the Healthcare Effectiveness Data and Information Set (HEDIS) relate to opioid, alcohol, and other drug use. According to the National Committee for Quality Assurance (NCQA), 90 percent of health plans use HEDIS to measure their performance in the realms of care and service. Providers, employers, consultants, and consumers then use this information to compare performance across health plans.

The NCQA, the private, nonprofit organization that maintains HEDIS, added seven new measures pertaining to health plan members for 2018. Unless otherwise indicated, measures are for those aged 18 years and older:

Use of opioids at high dosage: Measures the rate at which members receive an average morphine equivalent dose greater than 120 mg.

Use of opioids from multiple providers: Measures how many members receive opioids from multiple prescribers and pharmacies. Being on high doses of opioids and using multiple prescribers and pharmacies are risk factors for overdose and death.

Screening for unhealthy alcohol use and follow-up: Measures the percentage of members screened for unhealthy alcohol use. For those who screen positive, calculates how many receive appropriate follow-up care within two months.

Transitions of care: Assesses the percentage of inpatient discharges for Medicare members who received each of the following in a year: notification of inpatient admission, discharge information, provider contact after discharge, and medication reconciliation after discharge.

Follow-up care for those with high-risk multiple chronic conditions after an emergency department visit: Calculates the percentage of ED visits for Medicare members with high-risk multiple chronic conditions and those who received follow-up care within seven days of the ED visit.

Depression screening and follow-up for adolescents and adults: Calculates the percentage of members 12 years and older who were screened for clinical depression. Measures how many of those who screened positive then received follow-up care.

Pneumococcal vaccination coverage for older adults: Measures the percentage of members 65 and older who received the recommended series of pneumococcal vaccines, which includes 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine.

Revisions to Existing MeasuresIn addition to the changes noted below, the committee also introduced telehealth in seven behavioral health measures for 2018.

Alcohol and other drug abuse or dependence treatment: This measure, which assesses the initiation and engagement of treatment, now includes medication-assisted treatment (MAT) and telehealth as appropriate for those with alcohol and opioid dependence. Alcohol, opioid, and other drug dependencies also have been added as subgroups for reporting, and the engagement timeframe is now 34 days instead of 30.

Identifying alcohol and other drug services: This measure has been updated to include MAT as appropriate for those dependent on alcohol and opioids and allows reporting of measure rates by alcohol, opioid, and other drug dependence diagnosis as subgroups. For more granular reporting, NCQA is separating outpatient, ED, and telehealth services.

Immunizations for adolescents: The committee revised the vaccine rate for human papillomavirus (HPV) to permit a two-dose (instead of a three-dose) vaccination schedule for adolescents.

Breast cancer screening: Digital breast tomosynthesis (DBT) will be an acceptable breast screening test.

Plan all-cause readmissions: This measure has been extended to the Medicaid population.

NCQA also decided to exclude Medicare members enrolled in Institutional Special Needs Plans (I-SNPs) and living long-term in institutional care settings from HEDIS measures for breast and colorectal cancer screening, osteoporosis management for women who have had a fracture, and high blood pressure control. The committee decided that the measures are not appropriate from members who are frail or who are limited in mobility or function who would not benefit from the services.


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