Health equity takes center stage with new HEDIS quality measures

The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used methods for monitoring and measuring clinical quality and patient experiences.

More than 90 percent of health plans use HEDIS to keep tabs on their performance, creating an important opportunity to make apples-to-apples comparisons between hundreds of consumer options serving more than 190 million individuals.

The National Committee for Quality Assurance (NCQA), which curates and oversees the HEDIS framework, is continually updating and refining the components of the system to reflect the changing priorities and needs of the healthcare community.

In 2023, NCQA is adding and adjusting the HEDIS measures to throw additional weight behind arguably the most crucial topic of the modern era: health equity.

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The organization recently announced a series of new and revised measures designed to better uncover hidden disparities and hold health plans and providers to account for addressing issues that lead to unequal outcomes for specific socioeconomic groups.

“All of us at NCQA are committed to advancing health equity, starting with how we measure quality results,” said NCQA President Margaret E. O’Kane in a press release. “I thank the many people and groups who work with us and offer thoughtful guidance to help us evolve HEDIS to ensure that this important quality improvement tool helps people of all backgrounds.”

The changes are designed to collect better data across several key categories, including the social determinants of health, access to dental care, and the appropriate clinical treatment of elderly individuals.

Refining approaches to racial, ethnic, and gender identity data

Uneven collection of data related to race, ethnicity, and sexual orientation/gender identity (SOGI) can make it difficult to identify disparities and deploy high-impact interventions where they are most needed. NCQA has added race and ethnicity stratifications to eight HEDIS measures and has also revised measures related to pregnancy and childbirth to reflect that these events are not only experienced by those who identify as women.

The organization will continue to explore ways to incorporate more granular racial, ethnic and SOGI data to ensure accuracy and affirm gender identities to ensure appropriate care.

Enhancing the delivery of screenings for social needs

In addition, a brand-new measure will gauge social need screenings and interventions (SNS-E). The metric will assess measures who received screenings for unmet social and economic needs, such as food and housing security and transportation barriers. Health plan and provider participants will also be measured on whether these individuals receive a corresponding intervention if they are in need of help in these areas.

Improving quality measures for dental care on Medicaid

Access to high-quality pediatric dental care is a significant pain point for health plan members, particularly in the Medicaid space. While all children on Medicaid are entitled to dental services, less than half receive regular care from a dentist.

HEDIS will begin measuring the rate of comprehensive or periodic oral care evaluations among pediatric Medicaid members in 2023. Health plans will also need to collect data on topical fluoride application for children aged 1-4 years old, as this procedure is tied to fewer cavities and better oral health for young children.

Ensuring appropriate and quality care for older individuals

With Medicare Advantage still growing at a galloping pace, it is more important than ever to make certain that seniors are receiving the best possible care.

In the upcoming year, HEDIS will measure adherence to clinical guidelines about de-prescribing benzodiazepines in older adults (DBO) in a safe manner to avoid withdrawal symptoms and improve overall outcomes.

Another new measure will monitor emergency department visits for hypoglycemia in older adults with diabetes. To perform well on this metric, health plans will need to improve diabetes management among their older populations to avoid crisis-level events due to low blood sugar. 

These and other changes for the 2023 performance year will encourage health plans to work closely with providers on implementing proactive, preventive services across the entire care continuum. 

By holding health plans and their provider partners publicly accountable to higher standards of performance on these issues, HEDIS will become an even more powerful tool for moving the needle on crucial health equity concerns and improving outcomes for individuals in traditionally disadvantaged groups.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.