The National Committee for Quality Assurance is updating its Healthcare Effectiveness Data and Information Set or HEDIS scores for 2018 to include telehealth and to combat addiction risks associated with opioid use.
One new measure assesses the use of opioids at high dosage - an average morphine equivalent of more than 120 mg - for adults who receive long-term treatment.
Another addresses the rate of adult health plan members who receive opioids from multiple providers and pharmacies.
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"High dosage, multiple prescribers and pharmacies are all risk factors for dangerous overdose and death," the NCQA said. "These measures add health plans to the group of stakeholders currently addressing the opioid epidemic."
NCQA is updating an existing HEDIS measure to include medication-assisted treatment for people with dependence on alcohol and drugs.
It also adds telehealth as a treatment option for alcohol and other drug abuse or dependence treatment.
NCQA also added telehealth for behavioral health measures.
Additionally, alcohol, opioid and other drug dependencies are added as subgroups for reporting and the engagement timeframe is extended from 30 to 34 days. It separates care by outpatient, emergency departments and telehealth services.
Another measure assesses the percentage of health plans members found to be positive for unhealthy alcohol use who received follow-up care within two months.
Other changes to existing HEDIS measures include immunizations for adolescents for the human papillomavirus vaccine and breast cancer screening to include recent technology developments.
New measures include depression screening and follow up for health plan members 12 years and older and adults who were screened for clinical depression, found positive and who received follow-up care.
This completes a set of three measures to address the spectrum of care for depression from screening, ongoing monitoring and response to treatment.
Another measure improves care coordination during transitions for at-risk populations, including older adults and those with chronic conditions and more complex needs.
It assesses the percentage of inpatient discharges for Medicare members aged 18 and older who had, during the year, a notification of an inpatient admission, receipt of discharge information, patient engagement after inpatient discharge and medication reconciliation post-discharge.
Another measure is for a follow-up emergency department visit for people with high-risk multiple chronic conditions. It assesses the percentage of emergency visits for Medicare members 18 and older with high-risk multiple chronic conditions and follow-up care within seven days of the ED visit.
Another assesses the percentage of members aged 65 and older who receive the recommended pneumonia vaccine.
NCQA developed a strategy to extend the existing plan all-cause readmissions measure to the Medicaid population, essentially becoming a new measure for Medicaid.
NCQA is excluding Medicare members enrolled in institutional special needs plans or who live long-term in institutional care settings from measures for breast cancer screening, colorectal cancer screening, osteoporosis management in women who had a fracture and in controlling high blood pressure.
This is to ensure the measure only includes patients who actually benefit from the service, said NCQA is a private, nonprofit organization that accredits and certifies healthcare organizations.
HEDIS scores are used to measure performance.