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Medicare Advantage plans' quality measures face new changes

The National Committee for Quality Assurance wants to revamp some of the quality measures the CMS uses to evaluate the services of Medicare Advantage plans, and it’s looking for public feedback on those changes.

The National Committee for Quality Assurance (NCQA), a not-for-profit healthcare accreditor, wants to make several changes to the Healthcare Effectiveness Data and Information Set, or HEDIS, a longstanding measurement set that the organization helped develop and maintains for the CMS under a contract agreement. HEDIS is used by Medicare Advantage plans — and other health plans including commercial payers — to assess their performance. About 190 million people are enrolled in plans that report HEDIS results, according to NCQA’s website.

The CMS currently has several ongoing contracts with NCQA related to the maintenance of the HEDIS measures that total around $24.2 million, according to

NCQA would like to retire some measures, revise others and implement new ones. HEDIS has about 90 measures across six domains including experience of care and effectiveness of care.

NCQA said that it determines whether the HEDIS measures need revisions by monitoring changes in clinical guidelines and new evidence in the scientific literature. NCQA also convenes advisory groups of clinicians, consumers and purchasers to weigh in on the measures.

NCQA typically makes changes to the HEDIS measures every year but the proposed changes this year are “much more aggressive in number and scope than in the past years,” a spokesman said in an email.

The committee wants to retire an ambulatory care measure that summarizes utilization, osteoporosis testing in older women and the use of multiple antipsychotics in children and adolescents, among others.

It will add metrics for assessing whether adolescents and adults with treatment for substance use disorder received a follow-up visit or service and assessing whether women were screened for clinical depression during pregnancy and whether those who screened positive received follow up.

Additionally, NCQA is currently working on ways to improve data collection and reporting so it’s more efficient, according to their website.

Stakeholders have until March 11 to comment on the proposed changes.