HEDIS^® 2024 documentation for Care of Older Adults (COA)

Measure description: The purpose is to document the percentage of adults, 66 years and older, who had each of the following during the measurement year:

• Medication Review
• Functional Status Assessment
• Pain Assessment

What we are looking for in provider records:

• Medication Review: Members with both of the following during the same visit in the measurement year:
  • At least one medication review by a prescribing practitioner, or clinical pharmacist, and the date it was performed, along with the presence of a medication list in the medical record.
  • Notation that the member is not taking any medication, and the date it was noted.
• Functional Status Assessment: Members who had at least one Functional Status Assessment during the measurement year (2024):
  • Notation of Activities of Daily Living (ADL) were assessed, or that at least five of the following were assessed (bathing, dressing, eating, transferring, toileting, walking).
  • Notation that Instrumental Activities of Daily Living (IADL) were assessed, or at least four of the following were assessed (shopping for groceries, driving or using public transportation, using the telephone, cooking or meal prep, housework, home repair, laundry, taking medicines, handling finances).
  • Result of assessment using a standardized functional status assessment tool.
• Pain Assessment: Members who had at least one Pain Assessment during the measurement year:
  • Documentation that the patient was assessed for pain (positive or negative).
  • Result of an assessment using a standardized pain assessment tool or scale.
• Evidence of hospice services in 2024.
• Evidence patient expired prior to January 1, 2025.

Helpful hints:

• Encourage at least yearly visits. Older adults, many of whom have multiple, complex chronic conditions, require regular care addressing their physical, mental, cognitive, and behavioral needs.
• Most older adults take multiple drugs. A medication review to check safety and potential savings is recommended.
• Many older adults believe that pain is a normal part of aging. Regular screening for pain is recommended. Utilization of a standardized pain tool may assist in evaluating and adjusting care.
• Document, at least annually, ADL or IADL assessment:
  • Use the appropriate codes for Medication Review, Functional Status Assessment, and Pain Assessment whenever possible.