February 3, 2022
In
October 2021, the National Committee for Quality Assurance (NCQA) released
value set changes for the following Healthcare Effectiveness Data and
Information Set (HEDIS®) Quality measures:
New and
returning measures that are expected to be included in star ratings:
- Follow-up after emergency department visit for
people with multiple high-risk chronic conditions (FMC)
- Patients age 18 and older who have multiple
high-risk chronic conditions and who had a follow-up visit within seven days of
an emergency department visit.
- Plan all-cause readmissions (PCR)
- The number of acute inpatient and observation
stays for patients age 18 and older that were followed by an unplanned acute
readmission for any diagnosis within 30 days.
- Transitions of care (TRC)
- Patients who had an acute or non-acute
inpatient discharge during the measurement year and who had each of the
following:
- Notification of inpatient admission
- Receipt of discharge information
- Patient engagement after inpatient discharge
- Medication reconciliation post-discharge
- The comprehensive diabetes care (CDC) measures
have been separated as follows:
- Hemoglobin A1c control for patients with diabetes
(HBD)
- Patients ages 18–75 with a diagnosis of
diabetes (Type 1 or Type 2) whose HbA1c was adequately controlled (≤9%) as of
December 31 of the measurement year
- Kidney health evaluation for patients with diabetes
(KED)
- Patients ages 18–85 with a diagnosis of
diabetes (Type 1 or Type 2) who received a kidney health evaluation, defined by
an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine
ration (uACR), during the measurement year
Learn
more about these measures –including who is included in the measure, exclusions,
and tips –by clicking on the links provided above.
For more information
and/or questions regarding this article, email ProviderClinicalConsulting@Premera.com.
HEDIS® is a registered trademark of the National Committee
for Quality Assurance (NCQA).