HEDIS Breast Cancer Screening (BCS) update

Background

The U.S. Preventive Services Task Force (USPSTF) has joined other medical organizations in recommending that members of average risk for breast cancer begin routine screening at 40 years of age. Breast cancer screening in the form of screening mammography is recommended by the USTPSTF every other year beginning at age 40 and continuing until the age of 74.

Research has shown that more members are being diagnosed with breast cancer in their 40s.¹ Members who are diagnosed with early-stage breast cancer may be cured with fewer and/or less intense treatment and surgeries.

African American/Black members and members of Ashkenazi Jewish ancestry are at higher risk and are more likely to be diagnosed in their 40s with more aggressive breast cancer as referenced by the Breast Cancer Research Foundation (BCRF) and the American College of Radiology. However, there is a risk of more false positives among younger members who might have more dense breast tissue, making it harder to distinguish between normal and suspicious breast tissue on a screening mammogram.²

One option for members with dense breasts and others with a higher-than-normal risk for breast cancer is 3D mammography. Studies have found that 3D mammography reduces the chances of needing to return for more images when compared to a standard 2D mammogram. It also appears to find more breast cancers, and several studies have shown it can be helpful in members with more dense breasts.

How will NCQA collect data for HEDIS?

NCQA requires Breast Cancer Screening (BCS) HEDIS® data to be collected electronically. Data sources for HEDIS Electronic Clinical Data System (ECDS) may come from the electronic health record (EHR)/personal health record (PHR) and administrative data from claims. ECDS reporting can reduce the measurement rate and data exchange burden on your practices and may be more efficient and sensitive. Contact your provider relationship management representative for more information and assistance with establishing this connection.

As you review and screen your patients based on the guidance and their personal risk factors, be sure to clearly document the screening in your patient’s medical chart and in submitted claims, as well as clearly document any applicable exclusions such as bilateral or unilateral mastectomy or care-prohibitive conditions like living in a long-term care institution or advanced illnesses.

In addition, it is becoming increasingly important to identify the population served by race, ethnicity, preferred language, and socioeconomic status to help measure and address health disparities. MyDiversePatients.com and communityresources.elevancehealth.com are free resources that might help you with your diverse patient population.

Impact to patients

Unequal access to and utilization of screening mammography often leads to delays in the detection, diagnosis, and treatment, thus amplifying disparities in patient outcomes.³ Therefore, it is important to meet your patients where they are when discussing screening options; addressing barriers to care including beliefs, concerns, and issues of access and availability; and scheduling timely appointments and follow-ups.

Questions?

We’re committed to active involvement with our care provider partners and going beyond the contract to create a real impact on the health of our communities. Contact your provider relationship management representative for additional details and questions.