The Importance of Regular Updates to HEDIS Measures and Their Impact on Evolving Healthcare Practices

HEDIS is created and updated by the National Committee for Quality Assurance (NCQA). Since it started in 1993, HEDIS has been the national standard for checking the quality of health plans and providers. It has over 90 specific quality measures that cover preventive services, management of chronic diseases, behavioral health, access to care, how services are used, and patient experience.

These measures provide a clear way for healthcare groups to compare their performance, find areas needing improvement, and work toward better patient results. For example, HEDIS looks at asthma medicine use, diabetes care, blood pressure control, cancer screenings, vaccines, and help with quitting tobacco. These areas are important parts of patient care that affect long-term health.

HEDIS scores guide clinical quality as well as regulatory rules and payments. Programs like Medicare Advantage and Medicaid use HEDIS scores to determine star ratings, which affect how much health plans get paid and their position in the market.

Why Regular Updates to HEDIS Measures Matter

The healthcare world keeps changing because of new medical knowledge, changing rules, patient needs, and better health IT systems. HEDIS measures need to be reviewed and updated every year by the NCQA’s Committee on Performance Measurement.

Regular updates make sure the quality measures match the newest science and health policies. For example, recent updates have included adding transgender people to cancer screening rules, including COVID-19 vaccines in adult vaccine tracking, and focusing more on social factors that affect health.

In 2024, HEDIS added glucose management to diabetes measures alongside hemoglobin A1c. It also improved some measures to leave out people using diabetes medicine for reasons other than diabetes. These changes make the measures more accurate and easier to manage.

Some old measures have been removed, like Spirometry Testing for COPD and the Asthma Medication Ratio. Removing these helps providers focus on more important measures and use their resources better.

Impact of HEDIS Updates on Healthcare Providers and Organizations

Medical practice leaders and IT managers must plan and use resources well to keep up with HEDIS updates. Since most U.S. health plans use HEDIS, providers feel the effects of changes in quality measures.

• Financial Repercussions and Accreditation: Good HEDIS scores help health plans get better accreditation and higher payments under value-based care. Bad scores can cause penalties and reduce competitiveness, especially for Medicare Advantage plans where star ratings are public.
• Clinical Decision-Making and Care Coordination: Updated measures guide clinical work by focusing on new health priorities like better blood pressure control, improved diabetes care, and preventing unnecessary hospital stays. Providers use these measures to improve patient care plans.
• Data Management and Reporting: Electronic Clinical Data Systems (ECDS) help report HEDIS data more easily by pulling data directly from electronic health records instead of manual chart reviews. IT teams must make sure data is correctly captured, joined, and checked.
• Addressing Health Equity: Adding race and ethnicity breakdowns in some measures helps organizations find care differences among groups. This helps target efforts to provide fair care to all patients.

Evolving Focus: Social Determinants of Health and Telehealth Integration

Recent HEDIS updates focus more on social determinants of health (SDOH). Things like stable housing, access to food, and transportation affect healthcare access and results. Including SDOH in quality measures encourages healthcare groups to consider these issues when planning care.

Telehealth has grown in importance, especially since COVID-19. The Integrated Healthcare Association included telehealth rules in HEDIS for 2020. Virtual care helps keep access and manage chronic diseases when in-person visits are hard.

Young adults like Millennials and Gen Z prefer virtual visits. Health plans and providers that add telehealth can improve patient participation and following care guidelines in HEDIS.

Harnessing Artificial Intelligence and Workflow Automation for HEDIS Compliance and Quality Improvement

• AI-Enabled Data Analysis: With HEDIS reporting moving to digital methods, AI helps process data faster and more accurately. AI can pull needed quality data from Electronic Health Records, reducing manual work and mistakes. This accuracy is needed to meet NCQA’s HEDIS Compliance Audit™ rules.
• Predictive Analytics in Clinical Practice: AI tools check patient data to find people who might miss important tests or treatments. For example, AI can spot diabetic patients who need hemoglobin A1c tests or have medicine use problems that affect HEDIS scores.
• Workflow Automation for Routine Tasks: Automation can help with tasks like scheduling visits, sending patient reminders, and follow-ups. These are important for measures like post-hospital care visits and cancer screening follow-ups. Automation helps close care gaps.
• Patient Engagement Platforms: AI-powered messaging that matches patient needs and risks can improve following care plans. These platforms boost many HEDIS measures by encouraging timely screenings, shots, and disease monitoring.
• Integration with Telehealth and Remote Monitoring: AI helps analyze data from wearables or home tests. This supports ongoing care for chronic conditions and fits with HEDIS measures focused on controlling illness over time.

Adapting to Continuous HEDIS Evolution: Practical Strategies for Healthcare Organizations

• Invest in Robust Data Infrastructure: Use EHR systems that meet Fast Healthcare Interoperability Resources (FHIR) standards. This helps with smooth data sharing and reporting.
• Train Staff on HEDIS Updates: Regularly teach clinical and office staff about new measures and reporting rules. This improves readiness and compliance.
• Use Data Analytics Dashboards: Dashboards that update in real time can track HEDIS performance all year. This allows early fixes before formal reporting.
• Collaborate with Vendors: Work with vendors that provide digital health tools and reporting systems to ensure accurate data and patient involvement.
• Prioritize Equity and SDOH: Use social needs screening and outreach to meet care gaps found through race and ethnicity data.
• Leverage Telehealth Services: Include virtual visits to improve access and support following care services linked to HEDIS.

Wrapping Up

Regular updates to HEDIS measures are important to reflect what patients and health providers need. Updates based on new medical knowledge, policies, and technology keep these measures useful for guiding care.

Providers and healthcare leaders can use technology like AI and automation to handle the challenges of HEDIS compliance. These tools help improve patient care and get financial rewards linked to value-based care. Healthcare groups need to plan well and stay flexible as they work to improve care quality through these measures.