The National Committee for Quality Assurance (NCQA) is proposing requiring stratification by health member race and ethnicity as part of the measurement specifications for 15 additional Healthcare Effectiveness Data and Information Set (HEDIS) health care quality measures. HEDIS measures are commonly used by health plans, the Centers for Medicare & Medicaid Services in the Medicare and Medicaid programs, by the Health Resources and Services Administration for community health centers, and by Affordable Care Act health insurance marketplaces, to monitor and drive improvements in health care quality. The new stratification requirements would become effective for Measurement Year 2024:
NCQA began requiring race and ethnicity stratification for 5 HEDIS measures in Measurement Year 2022, and an additional 8 HEDIS measures in Measurement Year 2023:
The 15 additional measures being proposed for race and ethnicity stratification include 9 behavioral health measures, 3 prevention and screening measures, two diabetes measures, and a care coordination measure; many of the measures were considered for stratification in earlier measurement years:
Follow-Up After Emergency Department Visit for Mental Illness (FUM)
Follow-Up After Hospitalization for Mental Illness (FUH)
Depression Screening and Follow-up for Adolescents and Adults (DSF-E)
Prenatal Depression Screening and Follow-Up (PND-E)
Pospartum Depressions Screening and Follow-Up (PDS-E)
Utilization of PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
Use of Opioids from Multiple Providers (UOP)
Use of Opioids at High Dosage (HDO)
Risk of Continued Opioid Use (COU)
Prenatal Immunization Status (PRS-E)
Childhood Immunization Status (CIS-E)
Cervical Cancer Screening (CCS-E)
Eye Exam for Patients with Diabetes (EED)
Kidney Health Evaluation for Patients with Diabetes (KED)
Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC)
Given the increased awareness and interest in addressing racial and ethnic health care inequities, this proposed additional stratification by health plan member race and ethnicity will help identify those inequities, and highlight the need for specific and tailored quality improvement interventions to reduce those inequities.
NCQA is inviting public comments on this proposal through its comment portal:
Comments are due March 13, 2023.
Would like to see Hepatitis A, B, C and TB included in the table (measures).