The National Committee for Quality Assurance is emphasizing follow-up care, particularly for hypertension and breast cancer assessments, with its newest measure additions to the Healthcare Effectiveness Data and Information Set.
Starting next year, NCQA will be adding three new measures on which health plans will need to report. It will also remove four others and make a series of changes to existing measures, the organization announced Thursday. The HEDIS measures, which include data on preventive care services, treatment, equity and patient experience, are used by the Centers for Medicare and Medicaid Services and NCQA to calculate five-star ratings for Medicare, Medicaid and commercial insurers.
Related: NCQA health plan quality ratings include new equity measure
The new measures will track health plans’ rates of documenting mammogram results, following up with patients after abnormal breast cancer assessments and controlling blood pressure for patients with hypertension.
NCQA hopes these additions will support patients, including minority populations, that are at a higher risk for missing out on adequate follow-up care after initial treatment or diagnosis, said Jenna Barry, assistant director in the policy measures department at NCQA.
“A lot of our measure development process is looking to find different gaps in care that can be addressed,” Barry said.
NCQA will also be retiring a few measures from health plans’ data reporting next year, including its pain assessment indicator, antidepressant medication management and data source reporting requirements.
The nonprofit quality improvement organization is removing the pain assessment indicator from a measure on caring for older adults because it does not differentiate between acute and chronic pain or require the comprehensive examination necessary to effectively manage pain, Barry said.
“We're going to keep monitoring the field for evolving evidence and see if there's maybe a need in the future for a new measure that assesses pain specifically for older adults,” she said.
The antidepressant medication management measure will also be pulled in January, as it does not properly take into account non-pharmacological mental healthcare options.
Last year, insurers had high scores on NCQA’s equity measure, which was included in HEDIS for the first time and assessed whether health plans were prepared to report data stratified by members’ race and ethnicity. For the 2024 reporting period, insurers were asked to report at least one-fifth of their performance data by race and ethnicity. For 2025, the data source reporting requirement for measures stratified by race and ethnicity will be removed as it is overly burdensome for health plans, Barry said.
Several measures, including follow-ups after hospitalizations for mental illness and after chlamydia screenings, will be tweaked for next year.
NCQA updated its mental illness follow-up measure to include members with phobia and anxiety diagnoses as well as those diagnosed with self-harm and suicidal ideation. The measure will also recognize a broader set of follow-up options, including more types of providers, psychiatric residential treatment and peer support services for mental healthcare.
The organization’s chlamydia screening in women measure will include transgender members beginning in January as part of NCQA’s efforts to acknowledge and affirm health plan members’ gender identity.
“We're always trying to stay on top of how we can best help health plans address the needs of their members appropriately,” Barry said.
