Summary of NCQA’s HEDIS® 2021 Changes and New COVID-19 Technical Specifications

In Care Management, HEDIS & Quality Management, News by Marketing

In its continuing efforts to help health plans focus on quality care and respond to the challenges of COVID-19, NCQA has adopted sweeping changes to its HEDIS® measurement and reporting guidelines. Vital Data Technology has compiled and analyzed these changes and offers this overview of what plans should be aware of throughout the measurement year. Changes to the metrics fall into three categories:

New Measurements

Beginning with the MY2020/MY2021 reporting cycle, plans will be required to include measurement of three new focus areas:

  • Cardiac Rehabilitation comprising the percentage of members who attend cardiac rehabilitation following a qualifying cardiac event.
  • Kidney Health Evaluation for Patients With Diabetes consisting of the percentage of diabetic members who receive an estimated glomerular filtration rate and a urine albumin-creatinine ratio evaluation during the measurement year.
  • Osteoporosis Screening in Older Women which measures the percentage of women aged 65 to 75 who get screened for osteoporosis. 

Revised Measurements

Most of the revisions NCQA made to existing measurements are minor. There is, however, one major change to be aware of. The Well-Child Visits metric, formerly limited to the first 15 months of life, has been extended to the first 30 months. One other change of note: Palliative care exclusions are now required for several measures to ensure plans extend the most effective care to the patients who will benefit most, based on their conditions:

  • Breast Cancer Screening
  • Colorectal Cancer Screening
  • Blood Pressure Controls
  • Comprehensive Diabetes Care
  • Statin Therapy for Cardiovascular Disease
  • Osteoporosis Management for Women with Fracture

Retired Measurements

Finally, NCQA is discontinuing several measurements. This could cause some confusion, as 2020 measurements will be used for both 2020 and 2021 reporting cycles. For instance, the Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis report is required in MY 2020, but not in MY 2021. Other retired measurements include:

  • Adult BMI Assessment
  • Medication Management for People With Asthma
  • Medication Reconciliation Post-Discharge (Still collected as an indicator in the Transitions of Care measure)
  • Children and Adolescents’ Access to Primary Care Practitioners

NCQA has taken steps to reduce the risk to patients and workers in retrieving healthcare records and measurements. In our previous post, we discussed allowances for the greater use of telehealth technologies, including virtual check-in, e-visits, and patient-reported blood pressure readings. New guidelines also permit reimbursement for diabetic retinal eye exams read by artificial intelligence.

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Kelly Cieciorka MPA, HSA
Director of Quality

Kelly is the Director of Quality and Product Owner of Affinitē Quality™. She is responsible for guiding the quality product’s development and partnering with customers for successful implementation and optimization of the solution. Affinitē Quality is Vital Data Technology’s year-round HEDIS® and plan-defined quality management and submission module fully certified by NCQA for 2020 HEDIS measures.

She graduated from the University of San Francisco with a master’s degree in public administration. She has an undergraduate degree in pre-med and biology from the University of California, Santa Barbara.

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