HEDIS^® Changes for 2009

The National Committee for Quality Assurance (NCQA) has proposed three new measures to be added to the Healthcare Effectiveness Data and Information Set (HEDIS®). These measures are currently under review, but are expected to be part of the HEDIS review that will take place in the spring of 2009.

Following is some information about each of the new measures:

• The immunizations for adolescents (IMA) measure was created to improve the immunization status information collected and reported for the adolescent age group. The previous adolescent immunization measure (now retired) did not focus on whether adolescents received the correct immunizations at the recommended age; rather, it measured vaccination catch-up. Specifically, this measure will assess:
  
  

• The percentage of adolescents 13 years old who had one dose of Meningococcal conjugate vaccine, and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday. The measure calculates a rate for each vaccine and one combination rate.



• There are two new measures to address obesity in adults and children: the Body Mass Index (BMI) Assessment (BAA) and the BMI Percentile Assessment and Counseling for Nutrition and Physical Activity (BCA).
  
  

  • The BAA measure looks at the percentage of commercial, Medicaid and Medicare members 18-74 years old who had an outpatient office visit and who had their body mass index (BMI) documented.
  

• The BCA measure assesses the percentage of commercial and Medicaid members 2 through 17 years old who had an outpatient office visit and who had evidence of BMI percentile assessment, counseling for nutrition and counseling for physical activity during the measurement year.



• There are two new measures focused on medication use among Medicare members: the Care for Older Adults (COA) measure and the Medication Reconciliation (IMR) measure.
  

• The COA measure looks at the percentage of Medicare members 65 years old and older who received a functional status assessment, pain screening, advance care planning and medication review during the measurement year.

• The IMR measure assesses the percentage of discharges for Medicare members 65 years old and older that were followed by a medication reconciliation. There are two rates: one assessing if medication reconciliation was performed within 30 days of discharge and another assessing if medication reconciliation was performed within 60 days of discharge.

Please familiarize all clinical staff with these new measures and develop office protocols to comply with the recommended actions. For more information about HEDIS reviews, contact Darlene Holzbach in Humana’s Corporate Quality Management Department at dholzbach@humana.com or 502-580-5840.

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