NCQA: Scope of HEDIS 1999 more broad

Cardiac care, behavioral health, diabetes added

The final specifications for HEDIS (Health Plan Employer Data and Information Set) 1999 were released in September, and the National Committee for Quality Assurance (NCQA) claims it is much more broad in scope and application. "With HEDIS 1999, we’re turning up the lights in the health plan marketplace to show employees and employers just what they’re getting," notes NCQA president Margaret E. O’Kane.

HEDIS, a widely accepted performance measurement tool used to create report cards on managed care organizations, is used by more than 90% of the nation’s health plans, according to NCQA. This year’s version introduces a sophisticated new satisfaction survey applicable to all health plans, regardless of whether they serve commercial or Medicaid enrollees. In addition, HEDIS measures will for the first time include three key public health care concerns — cardiac care, behavioral health and diabetes — that will make survey findings of special interest to wellness professionals. (See complete listing of the HEDIS 1999 Reporting Set Measures, inserted in this issue.)

All three will provide valuable information relating to disease management. The cardiac care measures will assess whether members with heart problems or illnesses have had their Low Density Lipoprotein (LDL, or bad cholesterol) levels screened, and if it is under control.

The behavioral health measure provides important information about whether health plans are effectively managing patients with moderate to severe cases of depression who are being treated with antidepressant medication. Specifically, it looks at whether follow-up visits are sufficiently frequent to ensure optimal medication management (e.g., to adjust dosages, check tolerance), and how many patients are still on their medication after 12 weeks and after six months.

The comprehensive diabetes care measure — which is currently voluntary but which will become mandatory in the year 2000 — looks at whether people with diabetes are receiving appropriate preventive care, screening and monitoring. Specifically, it measures:

• whether diabetic patients’ glycohemoglobin was tested within the past year;

• if patients’ HbA1c level is controlled;

• if a lipid profile was performed;

• how well lipid levels are controlled;

• whether patients received a dilated eye exam within the past year;

•if patients’ kidney disease is appropriately monitored.

The technical details for this measure are available for download from the NCQA Web site at

[Editor’s Note: Organizations interested in learning more about HEDIS 1999 may attend the NCQA education conference, "An Introduction to HEDIS 1999," on Dec. 2, 1998, in Washington, DC. For more information, call the NCQA Customer Service Center at (202) 955-5697.]