HEDIS update adds cholesterol measures

NCQA turns focus on "intermediate outcomes"

The latest version of the Health Plan Employer Data and Information Set (HEDIS) moves yet further into the measurement of clinical outcomes with new performance indicators on cholesterol management after acute cardiovascular events and antidepressant management.

Critics have noted that effectiveness of care measures developed by the National Committee for Quality Assurance (NCQA) in Washington, DC, largely focus on processes of care rather than actual clinical outcomes of treatment. For example, several of the measures involve cancer screening and immunizations.

The new cholesterol measure will determine what percentage of health plan members with heart problems had their low density lipoprotein (LDL) level screened and whether the LDL was under control.

The antidepressant measure includes such issues as whether patients who first start taking antidepressants stayed on them for at least 12 weeks and whether patients treated with antidepressants stayed on their medications for at least six months. It will also look at the frequency of follow-up visits in antidepressant management.

NCQA spokesman Brian Schilling called these "intermediate outcomes" measures, incorporating both processes of care and outcomes. "This moves us toward the goal of including more outcomes in HEDIS," he says.

The NCQA has issued a draft version of the Diabetes Quality Improvement Project measures, which include a measure of blood glucose, which indicates whether diabetics are keeping their disease under control. That set is likely to become a part of the next version of HEDIS.

New surveys used

Health plan members also will provide new information for HEDIS 1999 through a different patient survey. NCQA has combined the previous member survey with the Consumer Assessment of Health Plans Study (CAHPS) survey developed by the Agency for Health Care Policy and Research. The CAHPS survey has been widely used with Medicare and Medicaid patients and will allow comparison of those groups with commercial insurance populations.

With a children's care survey, NCQA also will be asking parents to comment on their children's care. Developing new pediatric measures of care is an area of particular interest to NCQA, says Schilling. "That's one of the gap areas of HEDIS," he says. "We realize we need to beef up the measurement set."