Healthcare-related interest groups seized on the National Committee for Quality Assurance's recent invitation to comment on its new blueprint for evaluating health plans.
The NCQA said it received responses from 260 organizations representing providers, purchasers, public health agencies and public advocates during the two-month comment period that followed the July release of an expanded Health Plan Employer Data and Information Set. The comment period ended Sept. 3.
That feedback made enough impact to prompt the NCQA, a Washington-based healthcare evaluation agency, to revise and re-evaluate some of the 75 measures drafted for HEDIS' latest incarnation.
The NCQA plans to release a summary of changes made to the final HEDIS draft by the end of this month, said Carolyn Cocotas, the agency's assistant vice president for new-measure development.
But final touches still are being made to the measurement lineup and the corresponding technical specifications for collecting data on each measure, a result of comments from various organizations, she said.
The NCQA declined to give details of the revisions until the final document is released. But Cocotas gave an advance overview of the changes prompted by issues the organizations raised.
Comments and criticism involving two measures in the draft proposal were enough to cast doubt on their readiness and prompted the NCQA to recall them for additional scrutiny, Cocotas said. Some specific elements of other measures were changed to account for possible unintended negative effects on the provision of care, she said.
A yearlong study the NCQA conducted of the best measures the industry had to offer resulted in a two-tiered lineup of health-plan measures.
One tier was composed of rigorously tested and ready-to-go measures; the other was a list of measures that fulfill important and unmet evaluation needs but are still unproven and unrefined.
Generally a measure was consigned to the testing tier because of technical problems associated with capturing the necessary data or because of serious concerns over whether the measure was the best way to evaluate a certain clinical area.
In other cases, a debate arose over the frequency of actions such as medical screenings. The act of specifying how often a screening should be done by health plans has medical and cost implications, Cocotas said.
The screening of diabetic patients for damage to their retinas was one such service that got caught in a tug of war between medical necessity and wastefulness.
According to medical consensus, diabetics in more advanced stages of eye disease require eye exams every year, while those with mild or no eye disease can be safely screened every other year.
In a previous version of HEDIS, a retinal eye exam was required annually for diabetics. But in the draft of HEDIS 3.0, the measure was changed to capture the percentage of health-plan members with diabetes undergoing at least one eye exam in the past two years. Recent research had established that in many cases, the every-other-year screening frequency had no adverse medical effect on patients and could save on medical costs, Cocotas said.
The description of the measure included a proviso that some diabetics need more frequent screenings, but that didn't satisfy critics who worried that health plans would perceive the HEDIS mark as an industry standard and deny annual screenings to those who needed them, Cocotas said.
Statistical research hasn't progressed to the point where the two classes of diabetics can be identified and different requirements can be made for each, she said. The NCQA is setting its sights on building a measure to capture more effectively the equation of screenings measured against a diabetic's condition.
But because that allowance can't yet be made, the final HEDIS version will go back to the annual requirement for eye exams, Cocotas said.
Besides the comment on issues related to the substance of HEDIS measures, a significant proportion of the feedback had to do with the industry's transition to HEDIS 3.0.
Health plans are struggling with how quickly they can make that transition from current efforts to report multiple sets of measures for different populations, Cocotas said.
Originally devised for commercially insured populations, HEDIS spun off variations during the past few years for the divergent medical needs of Medicaid and Medicare enrollees.
Those discrete slices of the healthcare market are being consolidated and integrated through the HEDIS 3.0 development process.
The tendency is to want to move as quickly as possible to the new measurement system, but some employers may face a trade-off in comparison value, Cocotas said.
The new HEDIS is intended to make plan-to-plan comparisons more viable, but changing to a different program complicates an employer's efforts to build year-to-year comparisons of the health plans with which it contracts.
"You're either going to give up the ability to compare longitudinally or the ability to compare plans," Cocotas said.