September 2018
HEDIS® 2019 – Technical Specification Updates
The Healthcare Effectiveness Data and Information Set (HEDIS) is a measurement data set utilized by more than 90 percent of America’s health plans to assess health care trends, effectiveness and opportunities for improvement.
Participation in HEDIS is required by the Texas Health and Human Services Commission and Texas Medicaid. Blue Cross and Blue Shield of Texas (BCBSTX) assesses HEDIS data and performs HEDIS Hybrid audits yearly to assess performance, successes and opportunities for improvement.
For HEDIS Hybrid 2019, the National Committee for Quality Assurance (NCQA) has changed the technical specifications for the 2018 measurement year. The table below shows the measures assessed, their details and associated changes.
| Measure1 | Description | Associated Change |
| Adolescent Well Care (AWC) | The percentage of enrolled members ages 12 to 21 who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. | Specific mention of development must be mentioned to address physical and mental development components. Note that the following are no longer sufficient documentation for mental and physical development: • appropriate for age |
| Well-child Visits in the First 15 Months of Life (W15) | The percentage of members who turned 15 months old during the measurement year and who had six well-child visits with a PCP during their first 15 months of life. | Specific mention of development must be mentioned to address physical and mental development components. Note that the following are no longer sufficient documentation for mental and physical development: • appropriate for age |
| Well-child Visits in the 3rd, 4th, 5th and 6th Years of Life (W34) | The percentage of members ages 3 to 6 who had one or more well-child visits with a PCP during the measurement year. | Specific mention of development must be mentioned to address physical and mental development components. Note that the following are no longer sufficient documentation for mental and physical development: • appropriate for age |
| Weight Assessment and Counseling for Nutrition, and Physical Activity (WCC) | The percentage of members ages 3 to 17 who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year: • BMI percentile documentation • Counseling for nutrition • Counseling for physical activity |
Specified documentation of services rendered for obesity or eating disorders may be used to meet criteria for nutrition and physical activity counseling. |
| Prenatal and Postpartum Care (PPC) |
The percentage of live birth deliveries on or between Nov. 6 of the year prior to the measurement year and Nov. 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care: Timeliness of Prenatal Care Postpartum Care |
No changes in documentation from previous years. |
| Controlling High Blood Pressure (CBP) | The percentage of members ages 18 to 85 who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year. | No changes in documentation from previous years. |
| Comprehensive Diabetes Care (CDC) | The percentage of members ages 18 to 75 with diabetes (type 1 or type 2) who had each of the following: • Hemoglobin (HbA1C) testing |
No changes in documentation from previous years. |
| Childhood Immunization Status (CIS) | • 4 diphtheria, tetanus and acellular pertussis (DTaP); • 3 polio (IPV); • 1 measles, mumps and rubella (MMR); • 3 haemophilus influenza type B (HiB); • 3 hepatitis B (HepB); • 1 chicken pox (VZV); • 4 pneumococcal conjugate (PCV); • 1 hepatitis A (HepA); • 2 or 3 rotavirus (RV); and • 2 influenza (flu) vaccines |
MMR, VZV and HepA immunizations must now be given on or between the child’s first and second birthdays. |
Provider Call to Action: Take note of the above changes and ensure your documentation is reflecting the great care you provide to your patients. When records are requested for HEDIS review, please include all associated documentation (i.e., developmental screens with scores, patient handouts related to anticipatory guidance, immunization records, referral documentation and other pertinent information).
Reach out to the BCBSTX Quality Improvement contacts below if further information is needed. And watch for future information on how to prepare for the 2019 HEDIS Hybrid season in this newsletter.
Thank you for your continued collaboration and participation to ensure the best care for your patients.
| Kathleen Thompson, MPH, CHES, CHPQ |
Julie Sones, RN |
1HEDIS 2019 Volume 2: Technical Specifications for Survey Measures. National Committee for Quality Assurance
HEDIS is a registered trademark of NCQA.