Please note, this communication applies to Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.

 

The National Committee for Quality Assurance (NCQA) has changed, revised, and retired HEDIS® measures for measurement year 2022. Below is a summary of some of the key changes.

 

Diabetes measures

 

NCQA has separated the Comprehensive Diabetes Care indicators into stand-alone measures:

  • Hemoglobin A1c Control for Patients with Diabetes (Two rates reported: HbA1c Control (< 8%) and Poor Control HbA1c) (> 9%) (HBD)
  • Eye Exam for Patients with Diabetes (EED)
  • Blood Pressure Control for Patients with Diabetes (BPD)

 

The process measure Comprehensive Diabetes HbA1c testing was retired as the goal is to move toward more outcome-based measures.

 

Race/ethnicity stratification

 

An important step to address healthcare disparities is reporting and measuring performance. Given this, NCQA has added race and ethnicity stratifications to the following HEDIS measures:

 

  • Colorectal Cancer Screening (COL)
  • Controlling High Blood Pressure (CBP)
  • Hemoglobin A1c Control for Patients with Diabetes (HBD)
  • Prenatal and Postpartum Care (PPC)
  • Child and Adolescent Well Care Visits (WCV)

 

NCQA plans to expand the race and ethnicity stratifications to additional HEDIS measures over several years to help identify and reduce disparities in care among patient populations. This effort builds on NCQA’s existing work dedicated to advancing health equity in data and quality measurements.

 

Measure changes

 

Colorectal Cancer Screening (COL): Measures the percentage of members 45 to 75 years of age who had appropriate screening for ectal cancer. The Medicaid product was added to the administrative data collection method for this measure and the age range was changed to 45 to 75 years of age. Any of the following meet criteria:

 

  • Fecal occult blood test during the measurement year
  • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
  • Colonoscopy during the measurement year or the nine years prior to the measurement year
  • CT colonography during the measurement year or the four years prior to the measurement year
  • Stool DNA (sDNA) with FIT test during the measurement year or the two years prior to the measurement year

 

This measure can also be reported as an Electronic Clinical Data Reporting System measure: Colorectal Cancer Screening (COL-E).

 

Antibiotic Utilization for Respiratory Conditions (AXR): A newly added metric which measures the percentage of episodes for members 3 months of age and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event. This measure was added because antibiotics prescribed for acute respiratory conditions are a large driver of antibiotic overuse.

 

Tracking antibiotic prescribing for all acute respiratory conditions will provide context about overall antibiotic use. Given this new measure, the broader Antibiotic Utilization measure has been retired.

 

Use of Imaging Studies for Low Back Pain (LBP): This measure was expanded to the Medicare line of business, and the upper age limit for this measure was expanded to age 75. Additional exclusions to the measure were also added.

 

For a complete summary of 2022 HEDIS changes, visit: https://www.ncqa.org/hedis/measures/.

 

If you have any questions about this communication, call Anthem HealthKeepers Plus, Medallion Provider Services at 800‑901‑0020 or Anthem CCC Plus Provider Services at 855‑323‑4687.

 

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

 

AVA-NU-0555-22



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August 2022 Anthem Provider News - Virginia