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Breaking Down NCQA Specifications For MY 2020 and MY 2021

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In an unprecedented move, NCQA released the technical specifications for MY (measurement year) 2020 and MY 2021 at the same time earlier this month. The idea behind the simultaneous release of the technical specifications is to give health plans and vendors an opportunity to effectively plan for subsequent HEDIS® seasons. The new release calendar offers health plans an additional six months to plan, implement and track quality improvement efforts for MY 2021 season.

The new schedule includes final measure specifications for MY 2021 by March of that year as opposed to the existing process where final measure specifications are unavailable until October of the measurement year.

table showing HEDIS volumes and dates

Measure Catalogue Updates

The new specifications are in accordance with NCQA’s goal of outcomes-based care and improving the healthcare experience and focus less on the processes around care measures. Key changes for MY 2020 and MY 2021 measure catalogue include:

Addition of New Measures:

1. Cardiac Rehabilitation (CRE): The percentage of members 18 years and older with a cardiac event who attended cardiac rehabilitation.

2. Kidney Health Evaluation for Patients with Diabetes (KED): The percentage of members between 18-85 years with Diabetes who received a kidney health evaluation.

3. Osteoporosis Screening in Older Women (OSW): The percentage of women between 65-75 years who received osteoporosis screening.

Updated Existing Measures:

1. The former Well-Child Visits in the First 15 Months of Life (W15) measure is revised to Well-Child Visits in the First 30 Months of Life (W30).

2. The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV)

Retired Measures:

1. Adult BMI Assessment (ABA).

2. Board Certification (BCR).

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

4. Osteoporosis Testing in Older Women (OTO) (from the Medicare Health Outcomes survey).

5. Medication Reconciliation Post-Discharge (MRP) (This measure is still being collected as an indicator in the Transitions of Care measure).

6. Disease-modifying Anti-rheumatic Drug Therapy for Rheumatoid Arthritis (ART) (This measure is retired for MY 2021, but is reported for MY 2020).

7. Medication Management for People with Asthma (MMA).

Redesign Submission Layouts to Standardization of Measure Reporting

To ensure standardization across all submission layouts, NCQA has redesigned the IDSS (Interactive Data Submission System) module to be more structured and easier to interpret. The new schema segregates metadata and stratification (gender, age, socio-economic status) segments which includes only the elements that need to be reported by health plans. The NCQA has also redesigned the results layout which includes calculated values. The NCQA testing portal opens in August 2020 for vendors to test the new submission layout.

Public Reporting of One ECDS Measure

Electronic Clinical Data System measures promote expanded use of clinical data beyond traditional claims data and actively contribute towards meaningful clinical outcome measurement. The NCQA has finalized Prenatal Immunization Status (PRS) as the first publicly reported ECDS measure for MY 2020. The reason for shortlisting PRS measure is as follows – it was reported by multiple health plans and the results were variable. This indicates that data can feasibly be collected and there is opportunity for improvement due to variation in rates amongst the plans

Key Takeaways

  • NCQA’s move to release MY2021 specification along with MY2020 provides health plans with 11 more months to focus on improving the rates and track quality during the measurement period.
  • The new IDSS layout brings out significant changes in terms of standardizing schema and validating elements under various stratification. Health plans and vendors will need to work together to accomplish seamless transition.
  • These significant changes indicate a pragmatic move towards digitalization along with the introduction of ECDS (Electronic Clinical Data System) measure for public reporting, and forthcoming years would experience transition of traditional reporting to electronic reporting.


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