HEDIS® Updates, Resources, and What to

Expect for the 2020 Measurement Year

August 19, 2020

PL0853 0720

Agenda

1. HEDIS Results – MY2019Thomas Mendez & Rodney Truong

2. Changes to HEDIS MY2020 Ron Makita

3. HEDIS and Data Submission Resources Ron Makita & Rodney Truong

4. Pilot Projects Esther Bae & Grace Crofton

5. L.A. Care QI Initiatives & Tips Siddharth Raich

HEDIS® Results

HEDIS Submission – MY2019

• Due to COVID-19 and issues with collection, NCQA/CMS allowed Medicaid plans to use HEDIS 2019 hybrid rates if higher than 2020 and did not require Medicare plans to report.

• L.A. Care chose to report all of the 2020 rates as the measures that were lower were not significantly lower and fell within the same percentiles for Medi-Cal. Actual rates were also submitted for CMC and LACC.

• Using the actual rates:

‒ Demonstrates to leadership and external parties that we achieved comparable results even with COVID-19

‒ Allows us to maintain accurate year to year results for recommending real opportunities for improvement

‒ Unsure of how HEDIS 2020 rates will be used by NCQA going forward, so our rates will be accurately reflected

‒ For multi-year measures, allows compliant members to be used as standard data for MY2020

MY – Measurement Year

Managed Care Accountability Set (MCAS)

• For MY2019 (RY2020) DHCS announced a set of 39 clinical quality measures that must be reported.

• These MCAS measures replaced the External Accountability Set (EAS).

• 19 of those measures required Health Plans to achieve the 50th percentile as the Minimum Performance Level (MPL) and may impose penalties and/or require performance improvement plans for each of those measures not achieving the 50th percentile.

• Due to COVID-19 and issues collecting Medical Records from providers, the requirements of achieving the 50th percentile have been deferred this year.

RY – Reporting Year

DHCS – Department of Health Care Services

MY2019 – L.A. Care’s Performance

• Of the 19 measures from the MCAS measure set held to MPL:

‒ 17 measures met MPL

‒ AMR and W15 did not meet MPL.

• Well Child Visits in the First 15 Months of Life – Six or More (W15)

‒ Final rate: 55.72% (<25th percentile)

‒ H2019 was the first reporting year this measure was held to any

reporting requirements.

‒ Changes for MY2020: the measure is getting combined with other age

groups for the new well care measures.

0.00%12.45%

31.11% 29.93%

55.72%

50th Percentile 65.83%

0%

10%

20%

30%

40%

50%

60%

70%

H2016 H2017 H2018 H2019 H2020

RA

TE

REPORTING YEAR

W15TREND

MY2019 – L.A. Care’s Performance Continued

55.85%

57.58%

62.09%60.90%

59.56%

50th Percentile63.58%

54%

56%

58%

60%

62%

64%

66%

H2016 H2017 H2018 H2019 H2020

RA

TE

REPORTING YEAR

AMR TREND

• Asthma Medication Ratio (AMR)

‒ Final rate: 59.56% (25th percentile)

‒ Slight decline even though we have paid attention to it by designating as

a priority measure in VIIP, Provider Opportunity Reports, AMR

interventions, and internal dashboards.

‒ Need more focused efforts

Changes to MCAS for MY2020

• Going forward:

‒ Comprehensive Diabetes Care - HbA1c Testing (CDC) and Adult BMI

Assessment (ABA) will no longer be held to MPL.

‒ 4 additional measures will be held to the MPL

• 2 Admin, 2 Hybrid

New Measures for MCAS Measure Set – MY 2020

Measure Name Hybrid / Admin

Measure ID

Rate for MY2019 (%tle)

Metabolic Monitoring for Children & Adolescents on Antipsychotics – Blood Glucose & Cholesterol Total

Admin APM-03 53.58% (90th)

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications

Admin SSD 79.42% (33rd)

Weight Assessment and Counseling – Counseling for Nutrition – Total

Hybrid WCC-OB 78.33% (66th)

Weight Assessment and Counseling – Counseling for Physical Activity - Total

Hybrid WCC-OC 78.75% (66th)

HEDIS® MY2020: Summary of Changes

General Changes

• Technical Specifications that were released on 7/1/2020 are valid for

both measurement years 2020 and 2021.

‒ NCQA is transitioning to let health plans know what will be required

prior to the start of the measurement year.

‒ For MY2020, the final spec updates will be released on 10/1/2020.

‒ For MY2021 the final spec updates will be released on 3/21/2021.

• NCQA is changing from reporting year to measurement year, so next

year’s HEDIS will be MY2020 instead of 2021.

Changes to Telehealth Guidelines

• Telehealth visit guidelines were updated for 40 measures to support

increased use of telehealth caused by the pandemic.

‒ Some significant changes include Well Child visits and allowing

member-reported services for WCC-BMI Percentile, CBP, and CDC

blood pressure readings using a digital device (not a manual cuff).

• Telehealth visits can include virtual (interactive audio and video), telephonic

only, or e-visits (email or text messaging).

• For HEDIS services, providers should use the same codes as the in-person

visits and include the appropriate telehealth visit codes.

• Telehealth codes have been added to the HEDIS guides that are available

on the L.A. Care website.

Measures with Telehealth Updates

HEDIS Measure Name Acronym

Acute Hospital Utilization AHU

Adherence to Antipsychotic Medications for Individuals with Schizophrenia SAA

Antidepressant Medication Management AMM

Asthma Medication Ratio AMR

Breast Cancer Screening BCS, BCS-E

Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia SMC

Care for Older Adults COA

Colorectal Cancer Screening COL, COL-E

Comprehensive Diabetes Care CDC

Controlling High Blood Pressure CBP

Depression Screening and Follow-up for Adolescents and Adults DSF-E

Diabetes Monitoring for People with Diabetes and Schizophrenia SMD

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic

MedicationSSD

Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis- Scheduled for Retirement in MY2021 ART

Emergency Department Utilization EDU

Follow-up After Emergency Department Visit for Mental Illness FUM

Follow-up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions FMC

Follow-up After Hospitalization for Mental Illness FUH

Follow-up Care for Children Prescribed ADHD Medication ADD, ADD-E

Hospitalization Following Discharge from a Skilled Nursing Facility HFS

Hospitalization for Potentially Preventable Complications HPC

Mental Health Utilization MPT

NEW MEASURE: Cardiac Rehabilitation CRE

NEW MEASURE: Kidney Health Evaluation for Patients with Diabetes KED

NEW MEASURE: Osteoporosis Screening in Older Women OSW

Measures with Telehealth Updates (Cont.)

HEDIS Measure Name Acronym

Osteoporosis Management in Women Who Had a Fracture OMW

Persistence of Beta-Blocker Treatment After a Heart Attack PBH

Plan All-Cause Readmissions PCR

Postpartum Depression Screening and Follow-up PDS-E

Prenatal and Postpartum Care PPC

Prenatal Depression Screening and Follow-up PND-E

REVISED MEASURE: Child and Adolescent Well Care Visits WCV

REVISED MEASURE: Well-Child Visits in the First 30 Months of Life W30

Statin Therapy for Patients with Cardiovascular Disease SPC

Statin Therapy for Patients with Diabetes SPD

Transitions of Care TRC

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics APP

Use of Spirometry Testing in the Assessment and Diagnosis of COPD SPR

Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults DMS-E

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents WCC

Retired Measures

• Adult BMI Assessment (ABA)

• Medication Reconciliation Post-Discharge (MRP)

‒ Medicare only

‒ MRP is still measured in TRC (Transitions of Care)

• Medication Management for People with Asthma (MMA)

• Children and Adolescents’ Access to Primary Care Practitioners (CAP)

• Board Certification (BCR)

• Osteoporosis Testing in Older Women (OTO)

‒ Medicare only

Well Child Visits – W30

• Well-Child Visits in the First 30 months of Life (W30)

• W30 replaces the former W15 measure.

• This measure is broken down into 2 age groups with different requirements:

‒ Well-Child Visits in the First 15 Months is for children that turn 15 months old

and is similar to the retired W15 measure.

• Requires 6 or more Well-Child visits from birth to 15 months.

• The rates of 0, 1, 2, 3, 4, and 5 visits are no longer reported.

‒ Well-Child Visits for Age 15 to 30 Months is for children that turn 30 months

old during the year.

• Requires two Well-Child visits between 15 and 30 months of age.

• The retired W15 measure was hybrid and allowed for medical record review.

Only administrative visits qualify for the W30 measure.

Well Child Visits - WCV

• Child and Adolescent Well-Care Visits (WCV)

‒ This measure replaces the former W34 and AWC measures.

‒ Also adds in members from 7 to 11, so it covers all ages from 3 to 21.

‒ For all ages, one Well-Care visit during the year is required.

‒ There will be 3 separate age group rates reported, along with a total rate:

• 3 to 11

• 12 to 17

• 18 to 21

• The retired measures W34 and AWC allowed for medical record review. Only

administrative visits qualify for the W30 and WCV measures.

• It is critical that Well Visits are properly coded, as it will be difficult to reach the

MCAS MPL when required.

New Measures

• CRE (Cardiac Rehabilitation)

‒ Medicaid, Medicare, and Commercial

‒ Administrative measure

‒ The percentage of members 18 years and older, who attended cardiac

rehabilitation following a qualifying cardiac event, including myocardial

infarction, percutaneous coronary intervention, coronary artery bypass grafting,

heart and heart/lung transplantation or heart valve repair/replacement.

‒ Four rates are reported:

• Initiation - % of members who attended 2 or more sessions of cardiac

rehabilitation within 30 days after a qualifying event.

• Engagement 1 - % of members who attended 12 or more sessions of

cardiac rehabilitation within 90 days after a qualifying event.

• Engagement 2 - % of members who attended 24 or more sessions of

cardiac rehabilitation within 180 days after a qualifying event.

• Achievement - % of members who attended 36 or more sessions of

cardiac rehabilitation within 180 days after a qualifying event.

New Measures - Continued

• KED (Kidney Health Evaluation for Patients with Diabetes)

‒ Medicaid, Medicare, and Commercial

‒ Administrative measure

‒ The percentage of members 18–85 years of age with diabetes (type 1 and type

2) who received a kidney health evaluation, defined by an estimated glomerular

filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the

measurement year.

• OSW (Osteoporosis Screening in Older Women)

‒ Medicare only

‒ Administrative measure

‒ The percentage of women 65–75 years of age who received osteoporosis

screening.

HEDIS® and Data Submission

Resources

HEDIS Resources

• Updated HEDIS Guides are now available on the L.A. Care website on

the HEDIS Resources page.

• The guides include measure descriptions, examples of codes to submit

along with guidelines for Telehealth/Telephonic visits, and changes to

measures.

Direct Data Submission to QPM

• Quality Performance Management (QPM) encourages Plan Partners and IPAs to convert 837 encounter format to HEDIS format and upload directly to L.A. Care’s sFTP

‒ Bypasses data processing intermediaries (TransUnion); encounters are submitted directly to the QPM team to shorten the lag time and limit opportunity for data “leakage”

• The files go through L.A. Care’s automated file ingestion process (Clinical Data Integration)

‒ Files need to follow L.A. Care Data Submission Guidelines and naming convention

• L.A. Care communicates updates to guidelines as needed.

• If IPAs/Plan Partners have not received emailed guidelines and updates, please reach out.

‒ If files are rejected, L.A. Care will reach out to submitters to inform them of errors and request corrections to be made and re-submission of the files.

Supplemental Data Submission

• L.A. Care accepts data to be used as Supplemental Data to close gaps

that were not closed through the Claims/Encounter and Direct Data

channels.

• What’s needed:

1. Discussion with L.A. Care Quality Performance Management

team

2. HEDIS Roadmap Section 5

• Documentation about your sources/systems

3. Data

• May be subject to Primary Source Verification

• To move forward, please reach out to the Quality Performance

Management team to discuss strategy around the measures and

timing.

• HEDISops@lacare.org

• If during your review of Gaps in Care / Provider Opportunity Reports (PORs)

you see that gaps haven’t closed although the services have been

completed, please start the discussion as per the below steps.

1. Review with your IPA:

1. Did the member receive these services?

2. Did the provider report the service to the IPA?

3. Did the IPA send data to the Plan Partner and/or L.A. Care?

4. Did the IPA confirm that L.A. Care received data?

2. If IPA has submitted data but the POR still does not reflect this, then

discuss between the IPA and Plan Partner and/or L.A. Care.

3. Ensure that you utilize the current measure technical specifications and

are clear on the timing for providing services.

• For example, if a measure requires services during certain time of

the year, then research for services during that time.

Tip Sheet: What To Do If You Have Issues

• Steps that L.A. Care is taking to make the gap closure process more

efficient:

1. Reconcile with submitters (IPA, Plan Partners) to provide feedback on

files

2. Data layout and optimization opportunities

3. Impact of files as compared to gap in cares

4. Look into opportunities to make Gap In Care data more user friendly

and actionable

Process Improvements

Poll

HEDIS Strategies for Improvement:-i2i Population Health-Cozeva Bridge Platform

i2i Population Health

• i2i is a population health management tool used across health centers that helps health plans to:

‒ Electronically collect standard supplemental data

‒ Provide member history for new members to the clinics through its Unregistered Patient Manager

‒ Identify members with gaps in care

Pilot Project with i2i and L.A. Care

• The pilot project aims to collect more comprehensive data directly from selected

clinics via i2i.

• The goal is to increase administrative HEDIS rates, thereby reducing medical chart

pursuit, and to help clinics identify and outreach to patients that have not yet been

seen by the clinic.

Steps:

1. L.A. Care’s QPM team sends member attribution file of six selected clinics to i2i for a

duration of six months.

2. i2i member matches and extracts data (visits, labs, immunizations) from the clinics'

EHR systems.

3. i2i transmits data to the QPM team via secure File Transfer Protocol.

4. The QPM team processes and formats data into the L.A. Care HEDIS format.

5. The i2i data is ingested into the HEDIS engine.

6. i2i pushes member attribution file to the Unregistered Patient Manager.

7. Clinics outreach to members that are attributed to the clinic but have not yet been

seen by the provider.

• Joint sponsorship with Health Net to make available a widely used online provider

tool to close gaps in HEDIS and diagnoses for risk adjustment

‒ Agreement executed mid-July; implementation work underway

‒ Will be able to on-board providers and provider groups by November 2020.

• Providers access the platform via secure login.

• One online platform for L.A. Care and Health Net to facilitate exchange of real

time data between provider and plan on member diagnoses and services.

• Opportunity to monitor and track member Risk Adjustment Factor (RAF) scores

and progress toward goals for quality incentive programs.

• Data lag minimized with monthly data exchange from point of care and plan.

• Providers interested in participating should contact L.A. Care

‒ Hedisops@lacare.org

Applied Research Works: Cozeva Bridge Platform

Cozeva Bridge Platform – Sample Screenshot

Quality ImprovementInitiatives

Quality Improvement Initiatives Department

• The Initiatives team works on improving the quality of care for L.A. Care members by:

- improving HEDIS measure rates

- increasing member satisfaction (CAHPS)

- meeting accreditation requirements

• QI collaborates with other L.A. Care departments and external organizations e.g. IPAs, clinics, and CBOs

• Focused workgroups develop and implement interventions followed by evaluations for effectiveness

Priority Measures

AMR Asthma Medication Ratio

CDC-A1C Control CDC HbA1c Control (<8%)

AWC, W34, W15

(now W30, WCV)

Well visits for children <15 months, 3-6 y, 12-21y

PPC Prenatal and Postpartum Care

CIS-10 Childhood Immunization Status – Combo 10

+ Member experience

Measures of Focus

2020 Interventions - Member Outreach

Method Intervention

1. Robocalls• Well child visits• Breast, cervical, and colorectal cancer screening• Flu vaccine

2. Live calls• Medication adherence• Statin Adherence Calls (newly diagnosed

members are offered kits)

• Asthma educational kit• Breast, cervical, and colorectal cancer screening• CMC birthday card reminders for preventive

health

$• Follow-Up After Hospitalization for Mental

Illness Incentives

2020 Interventions - Provider

• Mailers

- ADHD medication prescriber letters

- Low back pain treatment guidelines

- Appropriate antibiotic prescribing toolkits

- Prescriber scorecards for pharmacy measures

• Calls

- Diabetes care recommendations

- Osteoporosis management

• Patient satisfaction tips emails

• Coaching calls with the QI team & promotion of the PORs

• Webinars

• Continuing Medical Education (CME) events - online

• Additional resources on lacare.org on HEDIS resources page

2019 Interventions – Community

• Social media campaigns

- Adolescent immunization

- Infant immunization

- Lead screening

- Cervical cancer screening

- Chlamydia screening

Asthma Kit

Recommended Interventions

• Utilize the Provider Opportunity Reports (PORs) to improve rates for key measures

- Identify missing data, members with gaps to conduct outreach to schedule appointments

- Remember there are financial incentives available via the Prop. 56 Value-Based Payment Program, Physician P4P, & VIIP

• Phone and video check-ins for chronic conditions and well-visits

- Especially for patients that canceled appointments in the past few months due to COVID concerns

• Facilitate curbside vaccination to minimize contact

- Utilize new vaccination reports

Sample Vaccination Report

Tips to Improve HEDIS Performance

• Communication and collaboration between IPAs and providers

‒ IPAs – please share information from L.A. Care with your providers!

• Focus on data completeness

‒ Coding matters!

‒ Consistent, accurate, timely data submission

‒ CAIR use for immunization measures

• Remember members, not just patients

• Run Plan-Do-Study-Act (PDSA) cycles

• Success = better care + better data

More resources available from L.A. Care

• Webinars, tips emails

- quality@lacare.org

• CME events

- lmercurio@lacare.org

• Online tools

- Printable, orderable patient educational materials

- Search for community resources

Contact

• Quality@lacare.org – Resources, interventions

• Incentive_Ops@lacare.org – PORs/Pay-for-Performance (P4P)

• HedisOps@lacare.org – Data submission

*All emails containing member PHI MUST be securely encrypted

(HIPAA 45 CFR §164.312(e)(1)).

Questions?