HEDIS standardizes processes for sampling

Unnecessary narrative measures are retired

While the 1998 update of HEDIS 3.0 remains basically unchanged, the Washington, DC-based National Committee for Quality Assurance (NCQA) did improve its performance measurement system with the addition of detailed guidelines for sampling processes and several important clarifications. The Health Plan Employer Data and Information Set 3.0/1998 also marks the retirement of a number of unnecessary narrative measures.

"We expect that health plans will have a relatively easy time adapting their systems to report HEDIS 3.0/1998 data," says Margaret E. O’Kane, NCQA president. "This update is fundamentally the same as HEDIS 3.0, but the improvements we’ve made should give employers, consumers, health plans, and others even more confidence in the comparability of HEDIS results."

Comparability is a big issue for the folks at NCQA. Last fall, the organization implemented a new audit process in response to complaints about variability in data collection. The audit process comprises a new volume in the update. This update also includes changes by the NCQA’s Committee on Performance Measurement (CPM), the broad-based group that is responsible for overseeing the evolution of HEDIS to improve standardized sampling techniques.

Specifically, HEDIS 3.0/1998 addresses concerns about variability in health plans’ methods of excluding members with contraindications and differences in the frequency and timing of sampling efforts. HEDIS 3.0/1998’s standardized sampling techniques will specify when, how often, and the precise methodology by which a health plan can establish a sample for purposes of calculating HEDIS data.

While no new measures are introduced in HEDIS 3.0/1998, many existing measures have been clarified and one, Treating Children’s Ear Infections, has been moved from the Reporting Set into the Testing Set. This will allow the CPM to examine several methodological issues with help from the Centers for Disease Control and Prevention. Currently, there are 56 measures in the Reporting Set and 30 measures in the Testing Set.

Among other significant clarifications, the definition of "continuous enrollment" as it relates to mergers and short breaks in coverage has been improved, and 14 narrative measures requiring plans to describe such aspects of their operation as physician compensation, utilization management processes, and rate trends in brief paragraphs have been eliminated because they were not useful for comparative purposes. The NCQA also determined that many of these areas were already being assessed more thoroughly as part of the NCQA Accreditation program.

The NCQA’s HEDIS Users Group (HUG) — health plans, employers, researchers, policy makers, that exchange information about successful HEDIS implementation strategies and concerns — contributed numerous suggestions for improvements to HEDIS 3.0/1998. Members of HUG also sit on expert panels charged with addressing methodological issues related to HEDIS data collection and calculation.

HEDIS 3.0/1998 includes two entirely new volumes. Volume 5, The HEDIS Compliance Audit Standards and Guidelines, includes all necessary information and documentation related to NCQA’s new audit program, which will promote the use of HEDIS data by giving employers and consumers even more confidence in the validity and comparability of HEDIS data. Volume 6, The Health of Seniors Survey Manual, includes background information about the Health of Seniors measure, the related survey instrument, and other information health plans and vendors will need to field the Health of Seniors survey and report results according to HCFA and NCQA requirements.

HEDIS volumes may be purchased separately or in a variety of packages. To order HEDIS 3.0/1998 or for pricing information, call the NCQA Publications Center (800) 839-6487. Or access the NCQA at its Web site at www.ncqa.com.