For Public Comment
November 13–December 11, 2014
Comments due 5:00 p.m. ET
December 11, 2014
Health Plan Accreditation
HEDIS/CAHPS Measures Required
for Reporting in 2016
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Note: This publication is protected by U.S. and international copyright laws. You may reproduce this
document for the sole purpose of facilitating public comment.
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HPA HEDIS/CAHPS Measures Required for Reporting in 2016
1
Overview
Our Mission: Improve the Quality of Health Care
NCQA is dedicated to improving health care quality.
For almost 25 years NCQA has driven improvement of the American health care system, helping to
advance the issue of health care quality to the top of the national agenda. NCQA’s programs and services
reflect a straightforward formula for improvement: measurement, transparency, accountability.
This approach works, as evidenced by the dramatic improvements in clinical quality demonstrated by
NCQA-Accredited health plans—health maintenance organizations (HMO), point-of-service (POS)
organizations, preferred provider organizations (PPO)—using both standards and performance results.
Today, 171 million Americans (54 percent) are enrolled in a plan that collects and reports HEDIS data to
NCQA.1
Background and Objectives
NCQA proposes updates to Health Plan Accreditation (HPA) in an ongoing effort to evolve the product
and align it with current market demands and stakeholder needs.
The objective of this public comment period is to seek feedback on proposed updates to HEDIS/CAHPS
measures required for reporting in 2016.
NCQA will hold a separate public comment for proposed HPA 2016 standard updates in March 2015.
Program Development to Date
The proposed recommendations align with NCQA’s mission to transform health care quality through
measurement, transparency and accountability. NCQA staff obtained input from the Standards
Committee, which has members from various stakeholder groups, including health plans, state and
federal government, consumer representatives and employer representatives.
1http://www.ncqa.org/ReportCards/HealthPlans/StateofHealthCareQuality.aspx
©2014 National Committee for Quality Assurance
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HPA HEDIS/CAHPS Measures Required for Reporting in 2016
Summary of Proposed Changes
HEDIS/CAHPS Measures Proposed for Reporting in 2016
In 2014 NCQA updated its Accreditation HEDIS measure scoring policy to require annual rescoring on
the same set of measures for each health plan, regardless of the standards year under which the
organization was accredited. The new scoring policy is effective for all health plans undergoing survey
under HPA 2015 and beyond. Prior to this update, plans were rescored annually on the set of measures
in effect during the original year of their Accreditation Survey. The change allows NCQA to make updates
to the set of HEDIS/CAHPS measures on an annual basis.
For reporting year 2016, NCQA is proposing to add measures from the existing HEDIS measure suite to
each of the product lines. The goal of this update is to continue to include a meaningful mix of measures
that effectively evaluate and differentiate health plan performance. The scope of this update will be more
limited relative to the measure updates implemented last year.
The final list of measures required for HPA submission and scoring in June 2016 will be released on
NCQA’s Web site in April 2015.
Measure Selection Process
The following criteria were used to select proposed measures for reporting in 2016:
 Proximity to value (i.e., cost/quality) and outcomes.
 Type of data required for measure reporting (i.e., administrative vs. hybrid).
 Measures present a strong case for the need for improvement.
 Measures address the needs of vulnerable populations.
 Plan performance and variability.
HEDIS/CAHPS Measures Proposed for Reporting in 2016
All measures suggested for reporting in 2016 have been approved for public reporting in Quality
Compass®. For reporting year 2016, NCQA proposes adding measures from the existing HEDIS measure
suite:
 Two for commercial plans.
 Two for Medicare plans.
 Three for Medicaid plans.
Table 1. Summary of HEDIS Measures proposed for inclusion for the 2016 Reporting Year
Commercial Medicare
Medicaid
Plan All-Cause Readmissions (PCR)


Asthma Medication Ratio (AMR)


Potentially Harmful Drug-Disease Interactions in the Elderly

(DDE)
Diabetes Screening for People With Schizophrenia or Bipolar

Disorder Who Are Using Antipsychotic Medications (SSD)
Flu Vaccinations for Adults Ages 18-64 (FVA)

NCQA also proposes the addition of one CAHPS measure to the commercial and Medicaid product lines.
Proposed measures require either administrative or survey data collection; none require manual chart
review.
© 2014 National Committee for Quality Assurance
Obsolete After December 11, 2014
HPA HEDIS/CAHPS Measures Required for Reporting in 2016
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Selection of these measures builds on efforts to emphasize outcome-oriented measurement. For
example, the Plan All-Cause Readmission measure is the strongest HEDIS outcome measure available
that also presents a strong case for improvement. Refer to Appendix 1: HEDIS Measures Proposed for
Reporting in 2016 for a full list of measures and their descriptions, data sources and rationales for
inclusion.
Table 2. Summary Count of HEDIS Measures in HPA for the 2016 Reporting Year (RY)
Measures
Measures
Proposed for
Total Measures
Total* Measures
Recommended for
Addition
Proposed for 2016
for 2015 RY
Retirement
to 2016 RY
RY
Commercial
25
0
2
27
Medicare
15
0
2
17
Medicaid
24
0
3
27
*The Comprehensive Diabetes Care indicators are counted as one measure.
NCQA also proposes to add the CAHPS Care Coordination (Q22) measure for inclusion in accreditation
scoring. The corresponding question for this measure asks respondents, “In the last 6 months [12 months
for adult commercial] how often did your personal doctor/child’s personal doctor seem informed and upto-date about the care you got from these doctors or other health providers?”
Given the increased focus on care coordination and patient-reported measures, inclusion of the Care
Coordination measure will strengthen the accreditation program.
Table 3. Summary Count of CAHPS Measures in HPA for the 2016 Reporting Year (RY)
Commercial
Medicare
Medicaid
Total Measures for
the 2015 RY
8
6
7
Measures
Recommended for
Retirement
0
0
0
Measures
Proposed for
Addition
to 2016 RY
1
0
1
Total Measures
Proposed for 2016
RY
9
6
8
Retired Measures
NCQA does not recommend retirement of any measures currently scored in accreditation, because:
 None of these measures are being considered for retirement from the HEDIS suite.
 There are no significant changes to the measures’ guidelines.
 The measures continue to meet NCQA criteria for inclusion.
Refer to Appendix 1: HEDIS/CAHPS Measures Proposed for Reporting in 2016.
Questions for Consideration
Consider the following questions for each product line separately.
1. Should NCQA include the HEDIS/CAHPS measures proposed for scoring in reporting year 2016?
If no, which measures should be excluded, and why?
2. Are there any scored HEDIS/CAHPS measures that you recommend for retirement?
If yes, which measures, and why?
© 2014 National Committee for Quality Assurance
Obsolete After December 11, 2014
4
About Public Comment
About Public Comment
Public Comment is integral to the development of all NCQA standards and measures. NCQA actively
seeks thoughtful commentary and constructive criticism from interested parties. NCQA seriously
considers all suggestions. Many comments lead to changes in our standards and policies and the review
process makes our standards stronger and more worthwhile for all stakeholders.
Refer to Submitting Comments, below, for details.
Documents
Draft changes to HPA 2016 are explained in detail in the following documents:
 Appendix 1: HEDIS Measures Proposed for Health Plan Reporting in 2016.
Account Set-Up
The public comment system is integrated with NCQA’s single sign-on platform. If you have access to any
of the systems listed below, you can use the same credentials to login and submit comments:
 Interactive Data Submission System (IDSS).
 Health Organization Questionnaire (HOQ).
 Download Center.
 Recognition Program Online Application.
 Quality Compass (QC).
 Policy/Program Clarification Support (PCS).
If you do not have access to any system listed, click the Create an Account button and complete the
entire form. Retain the password for your records.
Note: Use the Forgot Password button if you are unsure of your password. By using this feature, you
will change your password for all NCQA systems to which you have access.
Submitting Comments
Submit all comments through NCQA’s Public Comment Web site (publiccomments.ncqa.org).
NCQA does not accept comments via mail, e-mail or fax.
To enter comments:
1. Go to http://publiccomments.ncqa.org.
2. Select 2016 Health Plan Accreditation.
3. Click on the Instructions link to view public comment materials including instructions.
4. Select the Topic and Element (i.e., question) on which you would like to comment.
5. Select your support option (e.g., Support, Do not support, Support with modifications).
Note: If you choose Do not support, include your rationale in the text box.
If you choose Support with modifications, enter the suggested modification in the text box.
© 2014 National Committee for Quality Assurance
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About Public Comment
5
6. Enter your comments in the Comments box.
Note: There is a 2,500 character limit for each comment. Comments are cut off after 2,500
characters. Please be brief and to the point. We suggest you develop your comments in Word to
check your character limit, and save a copy for reference. Use the “cut and paste” function to copy
your comment into the Comments box.
7. Use the Submit and Return button to submit more than one comment. When you are finished
submitting comments, use the Submit and Logout button to receive an e-mail notification that
contains all comments you submitted.
All comments are due Thursday, December 11, by 5 p.m. ET.
Next Steps
The final list of measures required for submission and scoring in June 2016 will be will be released on
NCQA’s Web site in April 2015, following approval by the NCQA Standards Committee and the Board of
Directors.
NCQA will hold a separate public comment for proposed changes to HPA 2016 standards in March 2015.
© 2014 National Committee for Quality Assurance
Obsolete After December 11, 2014