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HEDIS Changes Reflect Focus on Health Equity

August 1, 2022
Healthcare Innovation
By David Raths

The nonprofit National Committee for Quality Assurance has revised quality measures for health plans in the Healthcare Effectiveness Data and Information Set (HEDIS) for measurement year 2023. NCQA has added race/ethnicity stratifications and made revisions to acknowledge and affirm member gender identity.

Collecting race and ethnicity data is key to improving health disparities, NCQA said. Better transparency into health plan performance by race and ethnicity will aid the illumination and investigation of care gaps and inequitable care so that the industry can learn from top performers. To identify and reduce disparities in care, NCQA has added race and ethnicity stratifications to eight HEDIS measures.

To ensure that HEDIS measures acknowledge and affirm members’ gender identity, NCQA has revised measures that reference pregnancy or deliveries to remove the limitation to women. This change acknowledges that pregnancy and childbirth are not experienced exclusively by individuals who identify as women, NCQA said, and will reduce the likelihood that transgender members are inadvertently excluded or inappropriately included in a measure due to gender identity. NCQA intends to explore other ways to make measures inclusive and affirming of sexual and gender minority members.

Another measure addresses Social Need Screening and Intervention (SNS-E).To encourage health plans to assess and address the food, housing and transportation needs of their patient populations, this measure helps health plans identify specific needs and connect members with resources necessary to address unmet social needs. This measure assesses members who were screened, using prespecified instruments, at least once during the measurement period for unmet food, housing, and transportation needs, and who received a corresponding intervention if they screened positive.

Other measures have been added to address pediatric dental care, safety and appropriateness, and diabetic care:

Oral Evaluation Dental Services (OED). Good oral health is vital to a child’s overall health, and oral examinations are important to prevent disease, reverse disease processes, prevent the progression of cavities and reduce the incidence of future lesions. This measure will help plans understand if their pediatric Medicaid members (under 21 years of age) receive comprehensive or periodic oral evaluations with a dental provider and will help improve access and utilization of dental services for members.

Topical Fluoride for Children (TFC). Dental cavities are the most common chronic disease in children in the United States. Topical fluoride plays an important role in preventing tooth decay. This measure will help plans understand if their pediatric Medicaid members, who are 1-4 years of age, receive at least two fluoride varnish applications and will help promote fluoride varnish treatments for younger members.

Deprescribing of Benzodiazepines in Older Adults (DBO). The 2019 American Geriatrics Society Beers Criteria recommends that benzodiazepines be avoided in older adults. Clinical guidelines recommend deprescribing benzodiazepines slowly and safely, rather than stopping use immediately, to minimize withdrawal symptoms and improve patient outcomes. This measure assesses Medicare members 67 years of age and older who were dispensed benzodiazepines and who achieved a ≥20% decrease reduction in benzodiazepine dose. This deprescribing measure presents an opportunity to promote harm reduction by assessing appropriate tapering of benzodiazepine use.

Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes (EDH). Older adults are more likely to experience severe hypoglycemia (low blood sugar), leading to fall-related events and fractures, increased risk of cardiovascular events and cognitive decline. Clinical practice guidelines for the treatment of older adults with diabetes emphasize the prevention of hypoglycemia and encourage avoidance of intensive glycemic control. Health plans have an opportunity to identify their older patients with diabetes (types 1 and 2) and measure the risk-adjusted ratio of observed to expected emergency department visits for those who are at the highest risk of hypoglycemia, and to implement appropriate interventions for prevention.

“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 statement. “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.”

Additionally, five HEDIS measures have been retired and others received modest changes. HEDIS 2023 also marks NCQA’s continued transition to Electronic Clinical Data Systems (ECDS) reporting, ensuring diverse clinical data sources inform quality measurement and quality improvement.

The rate of Americans diagnosed with diabetes isn’t slowing down, and the Covid-19 pandemic only exacerbated the risks and concerns for this debilitating chronic disease.

According to the American Diabetes Association, 1.5 million people will be diagnosed with diabetes this year. So why aren’t more people talking about it? The pandemic may have shifted the collective focus. After all, a nation in health crisis mode can only focus on so many problems at once. Yet hospitalizations and deaths due to diabetes or related complications were right behind the elderly and nursing home residents.

Aside from the pandemic pileup, the disease was not getting the attention it warranted, partly because of how the stigma attached to diabetes impacts our concern, even as it affects more people each year.

Between 1980 and 2014, the number of people with diabetes rose from 108 million to 422 million. “Prevalence has been rising more rapidly in low and middle income countries,” reports the World Health Organization. Diabetes can lead to blindness, kidney failure, heart attacks, stroke, and lower limb amputation.

Why Aren’t More People Talking About This?

“Diabetes is always swept under the rug because, in so many people’s minds, they just associate it with bad health habits and being overweight,” says Deena Fink of New York City. The Long Island native bartends in the West Village in addition to running a small online knitting business.

Most days, her Type 1 Diabetes doesn’t slow her down. It’s a disease she has been living with for sixteen years. “What really has to change is the stigma of diabetes,” Deena explains in an interview with Wealth of Geeks.

She is grateful for her health care plan, despite the roadblocks she often faces to receive her medication. “They have to start actually treating it as a chronic illness.”

Like many others during the first months of the pandemic, Deena was afraid to leave her house. “I didn’t even want to leave the house to go grocery shopping,” she says. The risks are different for someone with a chronic illness. “Just getting a cold, I am knocked out for several days.” She also could not get to a doctor’s office.

“You’re supposed to get your A1C done every quarter,” she explains, but she couldn’t see her doctor for a year and a half. So instead, Deena had to estimate what those numbers would be. The A1C test provides a three-month average of what blood sugar levels should be. It’s how a person with diabetes keeps themselves in range.

Deena faces a monthly battle with the insurance company just to receive her regular dosage of three insulin vials. Without insurance, she would have to pay $175 per vial.

The Global Factor

While lifestyle changes such as maintaining a healthy weight and diet, engaging in physical activity, and not smoking may decrease the health risks associated with diabetes, it does not guarantee that the disease won’t have harmful symptoms over time. Additionally, Covid-19 increases these risks across the globe.

Diabetes was responsible for 6.7 million deaths in 2021, according to the International Diabetes Federation. In addition to the 537 million adults living with diabetes today, an additional 541 million have Impaired Glucose Tolerance, a condition that places them at high risk of Type 2 Diabetes.

And what about the financial side? WHO reports that “diabetes caused at least 966 billion dollars in health expenditure – a 316% increase over the last fifteen years.”

As more people are diagnosed, the opportunity for visibility and change grows. Those with diabetes often become advocates for change.

“Stigma can result when you take an ‘invisible’ condition like diabetes out into the open,” says diabetes advocate Michael Donohoe of Ohio. When he was diagnosed with Type 2 Diabetes, he was also diagnosed with a heart condition. “I try to improve awareness and understanding by being as open about my diabetes as possible. I also advocate loudly for people who are newly diagnosed or severely impacted,” he says.

Covid Collision

Although the elderly and nursing home residents were hit hardest by the virus, people with diabetes were right behind them. This news comes to light as the total number of deaths in the United States nears one million.

“People with poorly controlled diabetes are especially vulnerable to severe illness from Covid, partly because diabetes impairs the immune system but also because those with the disease often struggle with high blood pressure, obesity, and other underlying medical conditions,” reports the New York Times.

Those with diabetes have to keep up with their disease constantly. “It’s a disease that’s a pain,” says Deena, “because you never stop taking care of yourself. Every decision you make for every day of your life will affect your diabetes.”

“It’s so much work,” she says, “but it keeps you alive.”

With diabetes diagnoses soaring across the globe, it is only a matter of time before the world stops hiding from this health crisis and confronts it head-on.

Read more on Healthcare Innovation

Stay Informed

HEDIS Changes Reflect Focus on Health Equity

Why Aren’t More People Talking About This?

The Global Factor

Covid Collision

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