State & FederalMedicaidDecember 31, 2020

Coding spotlight: HEDIS MY 2021

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

HEDIS overview

The National Committee for Quality Assurance (NCQA) is a non-profit organization that accredits and certifies health care organizations. The NCQA establishes and maintains the Healthcare Effectiveness Data and Information Set (HEDIS®). HEDIS is a tool comprised of standardized performance measures used to compare managed care plans. The overall goal is to measure the value of health care based on compliance with HEDIS measures. HEDIS also allows stakeholders to evaluate physicians based on health care value rather than cost. This article will outline specific changes to the HEDIS measures as outlined by the NCQA. The changes are effective for the measurement year (MY) 2020 to 2021. It is important to note that the state health agency has the authority to determine which measures and rates managed care organizations should capture.

 

HEDIS data helps calculate national performance statistics and benchmarks and sets standards for measures in NCQA Accreditation.

 

Health plans use HEDIS performance results to:

  • Evaluate the quality of care and services.
  • Evaluate provider performance.
  • Develop performance improvement initiatives.
  • Perform outreach to providers and members.
  • Compare performance with other health plans.

 

HEDIS MY 2020 new measures:

  • Follow-up After High-Intensity Care for Substance Use Disorder (FUI)
  • Pharmacotherapy for Opioid Use Disorder (POD)
  • Breast Cancer Screening (BCS-E)
  • Follow-up Care for Children Prescribed ADHD Medication (ADD-E)
  • Prenatal Depression Screening and Follow-up (PND)
  • Postpartum Depression Screening and Follow-up (PDS)

 

HEDIS MY 2020 retired measures:

  • Annual Monitoring for Patients on Persistent Medications (MPM)
  • Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC)
  • Standardized Healthcare-Associated Infection Ratio (HAI).

 

Retired measures are no longer maintained by NCQA or included in the HEDIS measurement set. NCQA has determined that specific measures are clinically inappropriate and are no longer in use. Once retired, the measures are not used in any product, program or service, and all use must stop.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

NYE-NU-0274-20 November 2020

 

PUBLICATIONS: January 2021 Empire Provider News