HEDIS® measurement year 2020: Medicaid summary of changes from NCQA

Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

 

Revised measures:

 

• The former Well-Child Visits in the First 15 Months of Life (W15) measure was revised to Well‑Child Visits in the First 30 Months of Life (W30). It includes two indicators:

  

Well-child visits in the first 15 months — children who turned 15 months during the measurement year with six or more well-child visits

Well-child visits for ages 15 to 30 months — children who turn 30 months during the measurement year with two or more well-child visits

  

• The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV):

 

The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year

Key measure changes:

 

• Controlling High Blood Pressure (CBP and CDC-CBP)
  Telephone visits, e-visits and virtual check-ins are now acceptable settings for blood pressure (BP) readings. Digital BP readings reported by the member are considered numerator compliant.

 

• Telehealth updates
  NCQA has updated telehealth guidance in 40 HEDIS^® measures for HEDIS measurement years 2020 and 2021. The purpose of these changes is to:

  

Support increased use of telehealth caused by the pandemic.

Align with guidance from Centers for Medicare & Medicaid Services and other stakeholders.

A list of the 40 measures can be found on the NCQA COVID-19 website at www.ncqa.org/covid.

 

New Medicaid measures:

 

Kidney Health Evaluation for Patients With Diabetes (KED) — The percentage of members 18 to 85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a uACR identified by both a quantitative urine albumin test and a urine creatinine test with service days four or less days apart during the measurement year

 

Cardiac Rehabilitation (CRE) — The percentage of members 18 years and older who attended cardiac rehabilitation following a qualifying cardiac event, including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, heart and heart/lung transplantation, or heart valve repair/replacement; four rates are reported:

 

• Initiation — The percentage of members who attended two or more sessions of cardiac rehabilitation within 30 days after a qualifying event

• Engagement 1 — The percentage of members who attended 12 or more sessions of cardiac rehabilitation within 90 days after a qualifying event

• Engagement 2 — The percentage of members who attended 24 or more sessions of cardiac rehabilitation within 180 days after a qualifying event

• Achievement — The percentage of members who attended 36 or more sessions of cardiac rehabilitation within 180 days after a qualifying event

 

Retired Medicaid measures:

 

• Comprehensive Diabetes Care (CDC) retired sub-measures —

 

Medical Attention for Nephropathy (retired for Commercial and Medicaid)

HbA1c control (< 7.0%) for a selected population

 

• Adult BMI Assessment (ABA)

• Medication Management for People With Asthma (MMA)

• Children’s and Adolescents’ Access to Primary Care Practitioners (CAP)
  
  

Measure change summary:

 

For a complete summary, go to https://tinyurl.com/NCQA-measures.

 

If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

 

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

 

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