If a telehealth consultation discusses and addresses a HEDIS / Stars quality gap, is Humana going to be able to capture that measure and give providers credit?

ANSWER: From a HEDIS perspective, telehealth is always acceptable for numerator compliance, unless the National Committee for Quality Assurance (NCQA) specifically excludes telehealth within their Technical Specifications. In the most recent guidance, these exclusions only apply to HEDIS measures targeting child and adolescent care. As always, it is important that related claims are coded appropriately and that services are documented accurately and completely in your patients’ outpatient medical record. Please reference this guide, PDF for coding information:

Telephonic and interactive video/audio consultations can be administered for the following HEDIS measures:

  1. Medication Reconciliation Post-Discharge (MRP)
  2. Care for Older Adults (COA) – Medication Review, Functional Status Assessment and Pain Screening, Advance Care Planning.
  3. Comprehensive Diabetes Care (CDC) – Medical Attention for Nephropathy, but only if the telehealth visit is with a nephrologist
  4. Transitions of Care (TRC)
  5. Follow-up after Emergency Department Visit for Patients with Multiple Chronic Conditions (FMC)

During a telehealth visit, information can also be gathered from patients regarding the administration and results of prior care. Submission of medical records with this care documented addresses these Stars HEDIS measures:

  1. Comprehensive Diabetes Care (CDC) – Eye Exam and Blood Sugar Controlled
  2. Breast Cancer Screening (BCS)
  3. Colorectal Cancer Screening (COL)

Additionally, healthcare providers are able to have conversations with their patients that impact HEDIS and other Stars measures that relate to care coordination and medication management. These discussions may also improve your patient’s experience and adherence with care plans and maintenance medication for chronic conditions.

Prescriptions can be provided for the following medications:

  1. Disease-Modifying Anti-Rheumatic Drug (DMARD) to address Therapy for Rheumatoid Arthritis (ART)
  2. Osteoporosis medications to address Osteoporosis Management in Women Who Had a Fracture (OMW)
  3. Statins for Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Use in Persons with Diabetes (SUPD)