Why CMS and NCQA Relaxed 2020 HEDIS® Reporting Requirements and Implications for 2021

In Covid-19, HEDIS & Quality Management by Marketing

NCQA’s and CMS’s relaxation of quality reporting and HEDIS® compliance requirements offers some welcome news in the ongoing battle against COVID-19. Both NCQA and CMS cited a number of factors in suspending data collection and reporting requirements. The primary concerns include the difficulty and risks involved in retrieving healthcare records in light of travel restrictions and additional exposure to the virus. These issues necessarily would have resulted in far fewer records being collected, which would have generated much smaller sample sizes than in previous years, posing the greater possibility of results that are not representative of the population.

Relief for Health Plans

As a result, commercial, Medicare, and Medicaid plans that use the hybrid reporting methodology had the option to substitute last year’s audited results (HEDIS 2019, reporting MY 2018 data)  in place of 2020 HEDIS numbers. While most plan quality-assurance teams understand the rules and reasoning behind the change, it is important to communicate the new policy to everyone in the organization.

This rotation of performance measures is allowed once every other year. While it may have made sense to take advantage of the opportunity this year, doing so will raise the stakes for ensuring proper diligence and accuracy in reporting next season’s HEDIS measurements. There is no guarantee that the current COVID-19 turmoil will have dissipated by then, so chart retrieval and data analysis may be just as difficult.

Diligence Still Required to Keep HEDIS Reporting on Track

Being relieved of the burden of collecting quality indicators does not mean plans should abandon the practice altogether. Any data collected this year can help identify care and outreach trends that can be useful in planning for future conditions. Given the uncertainty of the data and its magnified role in comparing and rating plans, It is more important than ever to engage a professional data analysis partner to interpret the data. 

Here’s why:

  • Results likely will contain numerous outliers and abnormal distributions.
  • A dedicated partner can enrich and smooth the data to improve their reliability.
  • These measures will be used as the basis for reporting and paying on value-based provider contracts.

Safety First According to NCQA

What That Means For Your Quality Team and Their Process

Collecting patient, treatment, and service data remains necessary, but plans and providers should take pains to adhere to CMS and NCQA advice. Data retrieval should not come before worker safety, nor should it risk diminishing member care or take focus away from COVID-19 containment and treatment measures. Payers should communicate openly with care providers to ensure as seamless a transition as possible to the dynamic COVID-19 environment.

Relaxed reporting regulations are not the only major changes brought about by the virus. NCQA and CMS have made additional COVID-19-related accommodations for the 2021 HEDIS season to allow expanded use of telehealth visits. We will discuss how health plans should respond to these changes in our next post.

Keep on Learning

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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