NCQA Adds New HEDIS Quality Measures to Improve Race, Gender Health Equity

The National Committee for Quality Assurance (NCQA) announced changes to its quality measures for the 2023 Healthcare Effectiveness Data and Information Set (HEDIS), including race and ethnicity data and gender-relevant care measures.

“All of us at NCQA are committed to advancing health equity, starting with how we measure quality results,” Margaret O’Kane, president of NCQA, said in the press release. “I thank the many people and groups who work with us and offer thoughtful guidance to help us evolve HEDIS to ensure that this important quality improvement tool helps people of all backgrounds.”

The quality measures for 2023 included significant updates in seven areas and retired measures in five areas.

NCQA has introduced race and ethnicity data stratifications to the HEDIS measures in an effort to incentivize health plans to take more decisive steps toward health equity.

The organization also revisited its measures related to pregnancy and childbirth. NCQA sought to reform its measures to be more inclusive of pregnant persons who do not identify as women. The changes seek to improve transgender care and health equity.

NCQA also sought to support better quality of care for pediatric dental services, specifically those covered by Medicaid programs. The quality measure recognizes plans that offer appropriate, periodic oral evaluations. These evaluations must be conducted by a dental professional and have the potential to protect minors against certain diseases and even reverse diseases.

In a similar vein, the committee introduced a quality measure for topical fluoride for children. Topical fluoride prevents cavities in children. By applying this quality measure to Medicaid plans, NCQA will be able to assess whether plans are encouraging fluoride varnish applications for children ages one to four.

The measures also seek to prevent seniors from receiving unnecessary benzodiazepines. These drugs are used to calm a patient and are not to be co-prescribed with opioids due to a higher risk of overdose, according to the National Institutes of Health’s National Institute on Drug Abuse. 

Specifically, the measure pursues a 20 percent or higher reduction in benzodiazepine dosage in Medicare beneficiaries of a certain age range.

The measures also seek to assess quality of care for health plan members with diabetes by evaluating care for members with diabetes and hypoglycemia. The measure tracks emergency department visits for hypoglycemia among members with diabetes.

“Health plans have an opportunity to identify their older patients with diabetes (types 1 and 2) and measure the risk-adjusted ratio of observed to expected emergency department visits for those who are at the highest risk of hypoglycemia, and to implement appropriate interventions for prevention,” the press release explained

Finally, NCQA’s HEDIS measures now include a social need screening and intervention measure. The goal of this measure is to identify and address members’ social determinants of health needs. The screening looks at food, housing, and transportation needs.

In the future, NCQA indicated that it would continue to investigate ways to create gender-inclusive quality measurements.

In the first half of 2022, NCQA awarded health plans for health equity innovation. In July 2022, Aetna announced that NCQA had recognized its California Medicaid plan for efforts to improve access to services that were sensitive to members’ cultural and linguistic needs. Shortly before Aetna’s announcement, Centene was recognized for its strategy to improve health equity in HbA1c testing.

In addition to efforts to make quality measures more inclusive, NCQA has called for the healthcare industry to move towards digital quality measures.