NCQA\u2019s public comment period is open and ready for your input.<\/p>\n
NCQA seeks public feedback on proposed new HEDIS\u00ae<\/sup> measures and changes to existing ones.\u00a0Reviewers are asked to submit comments to NCQA in writing via the Public Comment website<\/a> by 5:00 p.m. (ET), Friday, March 13<\/strong>. NCQA acknowledges that the healthcare policy environment is rapidly evolving, and we will consider all comments received, as well as any policy changes, as we prepare the final versions of these measures.<\/p>\n NCQA seeks comments on the following:<\/p>\n HEDIS measures are based on scientific evidence. When new evidence emerges, NCQA reviews the measures to determine if changes may be needed. NCQA convenes multi-stakeholder advisory panels\u2014including independent scientists, clinicians, health plans, purchasers, government and consumer groups\u2014to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.<\/p>\n An important part of developing and updating HEDIS is gathering input from the public. NCQA reviews all comments received during the public comment period, and discusses results with stakeholder advisors.<\/p>\n HEDIS measures do not constitute clinical practice guidelines and should not be used to determine insurance or coverage.<\/p>\n Follow-Up After Positive Colorectal Cancer Non-Invasive Screening Test: <\/em><\/strong>Assesses the percentage of persons 45-85 years of age who received a colonoscopy for a positive colorectal cancer non-invasive screening test.<\/p>\n Importance:<\/u><\/strong> Colorectal cancer represents approximately 8% of all new cancer cases and is the third most commonly diagnosed cancer in the United States.1<\/sup> Screening and early detection have a significant role in reducing the impact of this preventable and treatable disease.<\/p>\n Continuous Glucose Monitoring (CGM) Utilization for Patients With Diabetes: <\/em><\/strong>Assesses the percentage of persons 18-75 years of age with diabetes who had evidence of CGM utilization during the measurement period.<\/p>\n Importance:<\/u><\/strong> Continuous glucose monitoring supports diabetes management and helps prevent hypoglycemic and hyperglycemic events and other life-threatening complications.2<\/sup> Continuous Glucose Monitoring Utilization for Patients With Diabetes<\/em> is a utilization measure that provides visibility into CGM use patterns.<\/p>\n Intimate Partner Violence (IPV) Screening and Follow-Up: <\/em><\/strong>Assesses the percentage of persons 12-64 years of age who were screened for intimate partner violence using a standardized instrument, and who received follow-up care within 7 days of a positive intimate partner violence screening.<\/p>\n Importance:<\/u><\/strong> Intimate partner violence is a prevalent public health issue that harms individuals across every demographic group, with approximately 1 in 4 women and 1 in 7 men experiencing IPV in their lifetime in the U.S.3<\/sup> Screening and follow-up for IPV provide a standardized manner for healthcare teams to collect information about potential safety concerns and identify when additional assessment, support or referrals may be needed.<\/p>\n Person-Centered Outcome Measures<\/em><\/strong> (3 Measures):<\/strong><\/p>\n Importance:<\/u><\/strong> There is broad agreement that an individual\u2019s goals and priorities should guide care and the quality measures used to evaluate care.4-6 <\/sup>For older adults with multiple chronic conditions and functional limitations, clinical guidelines have indicated the importance of providing goal-based care.7,8<\/sup> For this complex population, goal setting has been shown to reduce patient-reported treatment burden and unwanted care, and it correlates with greater physical and social well-being and higher care satisfaction.9,10<\/sup><\/p>\n Prenatal Syphilis Screening and Follow-Up: <\/em><\/strong>Assesses the percentage of deliveries that had a syphilis screening with a documented result during the first trimester, within 14 days of the first pregnancy diagnosis or prenatal visit, or within 30 days of enrollment in the organization, and the percentage of deliveries with a positive syphilis screen that received appropriate follow-up care.<\/p>\n Importance:<\/u><\/strong> The prevalence of congenital syphilis is increasing exponentially in the U.S., with a maternal-infant transmission rate of almost 90%. In 2024, 3,941 infants were born with congenital syphilis\u2013a nearly 700% increase from 2015, when only 495 cases were reported.11<\/sup> Syphilis screening and timely follow-up during pregnancy have a significant role in reducing the impact of transmission and adverse health outcomes for both the pregnant person and baby.<\/p>\n Adult Immunization Status: <\/em><\/strong>Assesses the percentage of adults 19 and older who are up-to-date on recommended routine vaccines. The measure includes separate rates for influenza; tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap); zoster; pneumococcal; hepatitis B; and coronavirus disease (COVID-19).<\/p>\n NCQA proposes two updates to the pneumococcal indicator:<\/p>\n Emergency Department Utilization:<\/em><\/strong> Assesses the risk-adjusted ratio of observed to expected emergency department visits during the measurement period. NCQA proposes to expand this measure into the Medicaid product line for persons 18-64 years of age.<\/p>\n Pharmacotherapy Management of COPD Exacerbation: <\/em><\/strong>Assesses whether appropriate medications were dispensed following a chronic obstructive pulmonary disease (COPD) exacerbation for people 40 years of age and older within Medicare, Medicaid and Commercial product lines. The measure includes two separate rates: one that assesses whether a systemic corticosteroid is dispensed within 14 days of a COPD exacerbation event, and one that assesses whether a bronchodilator is dispensed within 30 days of a COPD exacerbation event.<\/p>\n NCQA proposes the following modifications to the measure:<\/p>\n The public comment period ends at 5:00 p.m. (ET) on Friday, March 13.<\/strong> Visit My NCQA<\/a> to submit comments. We’ve made some improvements to our site to make it easier for you to submit your comments.<\/p>\n For details on proposed changes, visit the NCQA website.<\/a><\/p>\n HEDIS\u00ae<\/sup> is a registered trademark of the National Committee for Quality Assurance (NCQA).<\/p>\n \u00ad1<\/sup>American Cancer Society. (2023). Colorectal Cancer Facts & Figures 2023-2025. https:\/\/www.cancer.org\/content\/dam\/cancer-org\/research\/cancer-facts-and-statistics\/colorectal-cancer-facts-and-figures\/colorectal-cancer-facts-and-figures-2023.pdf<\/a>.<\/p>\n 2<\/sup>American Diabetes Association. (2026). Continuous Glucose Monitors. <\/em>https:\/\/diabetes.org\/advocacy\/cgm-continuous-glucose-monitors<\/a>.<\/p>\n 3<\/sup>Stylianou, M.A. (2018). Economic Abuse Within Intimate Partner Violence: A Review of the Literature.<\/em> Violence and Victims, 33(1), 3. https:\/\/connect.springerpub.com\/content\/sgrvv\/33\/1\/3.full.pdf<\/a>.<\/p>\n 4<\/sup>McGlynn, E. A., Schneider, E. C., & Kerr, E. A. (2014). Reimagining Quality Measurement. New England Journal of Medicine, 371(23), 2150\u20132153. https:\/\/doi.org\/10.1056\/NEJMp1407883<\/a>.<\/p>\n 5<\/sup>Reuben, D. B., & Tinetti, M. E. (2012). Goal-oriented patient care\u2014An alternative health outcomes paradigm. The New England Journal of Medicine, 366(9), 777\u2013779. https:\/\/doi.org\/10.1056\/NEJMp1113631<\/a>.<\/p>\n 6<\/sup>Tinetti, M. E., Naik, A. D., & Dodson, J. A. (2016). Moving From Disease-Centered to Patient Goals\u2013Directed Care for Patients With Multiple Chronic Conditions: Patient Value-Based Care. JAMA Cardiology, 1(1), 9. https:\/\/doi.org\/10.1001\/jamacardio.2015.0248<\/a>.<\/p>\n 7<\/sup>American Geriatrics Society Expert Panel on the Care of Older Adults With Multimorbidity. (2012). Patient-centered care for older adults with multiple chronic conditions: A stepwise approach from the American Geriatrics Society: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Journal of the American Geriatrics Society, 60(10), 1957\u20131968. https:\/\/doi.org\/10.1111\/j.1532-5415.2012.04187.x<\/a>.<\/p>\n 8<\/sup>The American Geriatrics Society Expert Panel on Person-Centered Care. (2016). Person-centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15\u201318. https:\/\/doi.org\/10.1111\/jgs.13866<\/a>.<\/p>\n 9<\/sup>Tinetti, M. E., Naik, A. D., Dindo, L., Costello, D. M., Esterson, J., Geda, M., Rosen, J., Hernandez-Bigos, K., Smith, C. D., Ouellet, G. M., Kang, G., Lee, Y., & Blaum, C. (2019). Association of Patient Priorities\u2013Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions: A Nonrandomized Clinical Trial. JAMA Internal Medicine, 179(12), 1688\u20131697. https:\/\/doi.org\/10.1001\/jamainternmed.2019.4235<\/a>.<\/p>\n\n
About HEDIS and Public Comment<\/strong><\/h2>\n
Proposed New HEDIS Measures <\/strong><\/h2>\n
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Proposed Changes to Existing HEDIS Measures<\/strong><\/h2>\n
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How to Participate in Public Comment<\/strong><\/h2>\n
References<\/h3>\n