If a telehealth consultation discusses and addresses a HEDIS®/Stars quality gap, will Humana 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 specifically excludes telehealth within its 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 records.

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
  3. Transitions of Care (TRC) – Two of the four composite measures may be addressed via telehealth: Patient Engagement After Inpatient Discharge (TRC-PED) and Medication Reconciliation Post-Discharge (TRC-MRP)
  4. 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. Eye Exam for Patients With Diabetes (EED) and Hemoglobin A1c Control for Patients With Diabetes (HBD)
  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. Osteoporosis medications to address Osteoporosis Management in Women Who Had a Fracture (OMW)
  2. Statins for Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Use in Persons with Diabetes (SUPD)