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April 17 - 21, 2023
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HEDIS Then & Now

During the global pandemic, to reduce the spread of COVID-19 the healthcare industry shifted towards virtual care. Due to this National Committee for Quality Assurance (NCQA) expanded acceptance of telehealth services for patient encounters. It accommodates the new 40 HEDIS measures based on telehealth usages and performance in healthcare organizations during this pandemic.

Based on reports, the global telemedicine market size was $41.6 billion in 2019 and is projected to reach $396.8 billion by 2027.

Due to this Pandemic, NCQA has changed the reporting and data collection strategies to reduce the stress and health plan can take advantage of that

  • Promote the use of telehealth to improve/increase access to care, close gaps in care, improve health outcomes, and increase quality ratings.
  • Update processes to identify and exclude palliative care members from the HEDIS measures.
  • Health plans can now use supplemental data exchange for hybrid measure members. health plans can now use clinical data extraction on only those members in the medical record sample in their HEDIS project, versus the members in the measure’s entire population.
HEDIS and Star Rating Program

HEDIS measures are not exclusive to the Medicare star rating program. The HEDIS measures apply more than 412 Medicare plans, 171 medicate & 438 commercial health plans and they are essential to value-based care. HEDIS results are based on statistically valid samples of health plan members. Separate data samples are used for each measure.

There are two data collection methods for HEDIS measures; administrative and hybrid. Population data collection is information abstracted from different provider medical records, claim data, surveys, and internal data sources for a systematic sample of members from each Medicare Advantage, MA, plan.

Plans receive these members’ names after the top of the measurement year and pursue the gathering of medical records from February through May. Submitted data is employed when assessing hybrid and medical history Review, MRR, measures, but can’t be accustomed assess administrative-only measures.

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