Posted by Kaitlyn Schnell
As a provider, you play an important role in improving clinical performance through Healthcare Effectiveness Data and Information Set (HEDIS). Whether it’s providing appropriate care within the designated time frames, documenting care in patients’ medical records, accurately coding claims, or supplying a timely response to medical records requests, promoting the well-being of health plan members is always at the top of your mind.
And as the healthcare industry transitions towards value-based care, a good HEDIS score from the National Committee for Quality Assurance (NCQA) is vital to remaining competitive. Staying up to date on new and edited measures will help you stay compliant. We've created a HEDIS 2021 cheat sheet to help you do just that.
HEDIS Revisions for Measurement Years (MY) 2020 and 2021:
- Well-child visits in the first 15 months of life (W15) measure is revised to well-child visits in the first 30 months of life (W30)
- Well-child visits in the third, fourth, fifth, and sixth years of life (W34) and adolescent well-care visits (AWC) have been combined into child and adolescent well-care visits (WCV)
- In response to the pandemic, telephone visits and online assessment value sets were added to some measures, including SAA, SSD, ADD, FUH, FUM, AMM, SMC, SMD, CBP, SPR, BCS, CDC, and others
- New value sets were added to the following measures:
New HEDIS Measures:
- Cardiac rehabilitation (CRE): helps to identify the member 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
- Kidney health evaluation for patients with diabetes (KED): helps to identify the members with diabetes (type 1 and 2) who received a kidney health evaluation
- Osteoporosis screening in older women (OSW): helps to identify the women who received osteoporosis screening
Retired HEDIS Measures:
- Adult BMI Assessment (ABA)
- Medication management for people with asthma (MMA 50 percent and 75 percent)
- Disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis (ART) (This measure is reported for MY 2020 but is retired for MY 2021)
- Children and adolescents’ access to primary care practitioners (CAP)
- Comprehensive diabetes care: HbA1C less than 7 & medical attention for nephropathy indicators
How to Improve Your HEDIS Scores:
Simply being aware of the new HEDIS quality measures isn't enough to improve your score. Here at Meditab, we provide our clients with support and training for not only our Intelligent Medical Software (IMS), but we also equip you with a variety of healthcare-related resources, like HEDIS training. Take a look at one of our recent webinars, "HEDIS 101: Your Strategic Guide to Ensuring Compliance and Higher Scores," to see how you can avoid gaps in care, get monthly HEDIS star reports, receive performance incentives, and utilize our teams to help you master HEDIS.
