« Back to Blog

Are You Ready for the 2018 HEDIS Measurement Changes?

No one can deny the positive impact NCQA’s HEDIS® performance measures have had on improving the quality of healthcare. Yet, the term “HEDIS” often sends shudders down the spines of health plan executives.

Meeting HEDIS measure requirements and improving results is a major challenge. It’s time intensive and requires considerable financial investment. However, demonstrating quality through good HEDIS outcomes is important for the financial success of health plans, especially Medicare Advantage plans.

To ensure future success, health plans need to start becoming educated on — and planning for — the 2018 HEDIS changes today. In addition, they need to evaluate their 2016 results to identify gaps in current efforts and create new strategies for measure improvement.

“Now is the time to revise the processes and strategies that did not produce targeted results and review the new HEDIS specifications that will require changes,” says Jennie Echols, PhD, MSN, RN, Director of Clinical Solution Development, Carenet Healthcare Services. “Health plans need to be selecting the right vendor now to help develop and implement new strategies to achieve the improvement results needed.”

New 2018 HEDIS Measures
Following is a recap of NCQA’s seven new quality measures for 2018.

1.     Transitions of Care: Assesses percentage of inpatient (IP) discharges for Medicare members who had each of the following during the measurement year:

  • Notification of IP Admission
  • Receipt of Discharge Information
  • Patient Engagement After IP Discharge
  • Medication Reconciliation Post-Discharge

2.     Follow-up After Emergency Department (ED) Visit for Medicare Members with High-Risk Multiple Chronic Conditions (Follow-up care within seven days of ED visit)

3.     Use of Opioids at High Dosage: Assesses rate of all health plan members who receive long-term opioids at high dosage

4.     Use of Opioids from Multiple Providers: Rate of all health plan members who receive opioids from multiple prescribers and multiple pharmacies

5.     Depression Screening and Follow-Up (if screened positive) for Adolescents and Adults

6.     Unhealthy Alcohol Use Screening and Follow-Up within two months (if screened positive)

7.     Pneumococcal Vaccination Coverage for Older Adults

Changes to Existing Measures
Significant changes were made to four existing measures for 2018.

1.     Telehealth for Behavioral Health Measures: NCQA introduced telehealth in seven behavioral health measures, such as allowing one follow-up visit to occur via telehealth for children prescribed Attention Deficit Hyperactivity Disorder (ADHD) medication.

2.     Mental Health Utilization (MPT): Added telehealth modifiers

3.     Plan All-Cause Readmissions: Added the Medicaid product line

4.     Breast Cancer Screening: Added digital breast tomosynthesis to numerator criteria

Carenet Can Help
With nearly 30 years of working with close to 100 healthcare clients and millions of people across all populations, Carenet has the experience, solutions and technology needed to measurably improve a health plan’s 2018 HEDIS outcomes. Here are a few ways we can help:

  • Virtual Care: With the advent of new telehealth codes for behavioral health measures, Carenet’s 24×7 Virtual Clinic telehealth offering can be used to facilitate appropriate access to virtual behavioral health providers.
  • Post-Discharge Outreach: We will proactively contact members discharged from the ER or hospital to schedule follow-up appointments; uncover and address barriers to successful recovery; and assist with medication management to prevent future unnecessary ER visits or hospital admissions.
  • CAHPS Surveys: Carenet will perform a pre-CAHPS simulation survey to help increase plan scores. We will call members the quarter before the survey to emphasize available resources and how much their plan cares about their wellbeing. This approach has proven to positively influence results.
  • Strategic Engagement: Members will be advised on health plan incentives and preventive care services, such as well-child visits, immunizations, vaccinations and health screenings (e.g., mammograms, colonoscopies). We will help schedule appointments with multiple providers; coordinate transportation if required; and conduct follow-up calls to ensure appointments were kept and assist with rescheduling if needed.

“The most effective approach to HEDIS is a year-round engagement strategy with strategically timed quarterly touch points,” advises Echols. “Proactive, personalized interventions that incorporate persuasion and influence techniques help drive member activation, close gaps in care, reduce costs and improve HEDIS scores.”

To learn more, click here to download Carenet’s e-book HEDIS Best Practice Guide: Proven Strategies for Closing Gaps in Care. 

Join Dr. Echols at the RISE West Summit
Are you interested in integrating persuasion and influence techniques into your engagement strategy? Join Dr. Echols at the RISE West Summit for a roundtable discussion on her recently published white paper, Beyond Engagement: Strategies for Persuasion and Influence.

When: Monday, September 18, 4:00 – 5:00 p.m. (three 20-minute sessions will take place).

If you’re unable to join Dr. Echols’ presentation but would like to learn more, please stop by our booth or contact us to schedule an on-site or pre/post-summit meeting by clicking here or calling 800-809-7000.

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

Healthcare Innovations

Insights into Consumer Health

  • Blog

  • E-Book/White Paper

  • News

Healthcare Innovations

Let's talk

Let’s talk about how our positive impact on consumer health choices can help you meet your goals.

Contact Us