B-TAC

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Inside the Beltway: C-TAC Responds to HEDIS 2020 Measures

C-TAC commented this week to NCQA on the following measure changes for the HEDIS data set, which is used to assess performance improvement for health plans covering 190 million Americans:

  • Care for Older Adults—Functional Status Assessment – We reluctantly supported the proposed change to remove a component of the measure having to do with functional assessment. That component was inconsistently applied, but we recommended that NCQA work with CMS to confirm a more consistent and administratively acceptable way to assess functionality given its significant to the care for older adults. We also suggested that such a new measure should also be validated for use in all Medicare situations, not just Special Needs Programs (SNPs), which is the case with the current measure.
  • Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly – We supported the proposed changes as using antidepressants in the elderly may sometimes outweigh their risk of contributing to falls. * Use of Opioids at High Dosage- This change was to bring the measure in line with the CDC Pain Management Guidelines by reducing the opioid alert dose from 120MME to 90MME. However, we commented that we had concerns about those with serious illness who legitimately need higher doses than 90 MME/day. For that reason, we urged NCQA to exempt those on palliative care from this measure, as that population is exempted in the CDC Guideline it’s based on and also for the Part D Opioid Overutilization Program.
  • Use of Opioids at High Dosage – This change was to bring the measure in line with the CDC Pain Management Guidelines by reducing the opioid alert dose from 120MME to 90MME. However, we commented that we had concerns about those with serious illness who legitimately need higher doses than 90 MME/day. For that reason, we urged NCQA to exempt those on palliative care from this measure, as that population is exempted in the CDC Guideline it’s based on and also for the Part D Opioid Overutilization Program.

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