Telehealth and its usefulness is constantly growing. In the past few years, the NCQA, or National Committee for Quality Assurance, has gradually made changes to HEDIS (Healthcare Effectiveness Data and Information Set) that allow telehealth to be used as a quality measurement of providers. In 2020, even more changes were added, which shows just how serviceable telehealth can be, especially in its measurement and management of chronic diseases and conditions in a value-based care environment. 

 

Telehealth Integration into HEDIS

HEDIS is one of health care’s most used tools to measure the performance of providers. About 191 million patients use plans that report data to the NCQA to rank patient outcomes against HEDIS standards. There are 6 domains that providers are assessed on, and they include:¹ 

 

  1.   Effectiveness of Care

  2.   Access/Availability of Care

  3.   Experience of Care

  4.   Utilization and Risk-Adjusted Utilization

  5.   Health Plan Descriptive Information

  6.   Measures Collected Using Electronic Clinical Data Systems

 

Between these 6 domains, there are over 90 more specific measures used to assess health plans and other participating health care organizations. Most importantly, these results are used to make improvements for the future, and telehealth has been a focus for HEDIS revisions in 2020. As of this year, more than 90 percent of measures included in HEDIS 2020 allow for one modality of telehealth in lieu of a face-to-face visit.²

 

“Telehealth is simply the right thing to do…The benefits of telehealth are evident to NCQA.”²

 

Telehealth and the Value-Based Care Environment

In the coming years, it will be imperative that providers start to align more of their efforts with changing HEDIS standards, which could mean adopting telehealth. CMS has set value-based care to be a priority by 2024, which incentivizes providers to provide quality care for reimbursement purposes. The Medicare Access and CHIP Reauthorization Act (MACRA) permanently repealed the sustainable growth rate (SGR) model, and established a two-track Quality Payment Program. Under the model physicians must choose one of two paths:³ 

 

1.  Advanced Alternative Payment Models (AAMPs), in which a limited number of spots are available for qualified physicians who must choose one subpath of: 

    • Joining a Comprehensive Primary Care Plus
    • Participating in a Medicaid Shared Savings Program 
    • Joining a Next Generation Accountable Care Organization 

 

2.  Merit-Based Incentive Payment System (MIPS), in which physicians must do all of the following: 

    • Increase the quality of care
    • Promote interoperability 
    • Decrease costs
    • Take active steps to improve quality of care 
      • The performance of all of these steps listed above culminate into a final score, in which physicians receive a payment adjustment based on two years prior. 

 

Some of the quality measurements used in MACRA are also used for HEDIS standards, which is why looking at telehealth as a way to improve scores for both measurement systems is important. Telehealth directly affects the first three domains of HEDIS: Effectiveness of Care, Access/Availability of Care and Experience of Care. 

 

Digital Health in Practice

Telehealth has been proven to increase patient satisfaction and improve patient outcomes through continuous contact and connection with their providers. Patients who use telehealth, especially for chronic conditions, see lower rates of hospital readmission, which proves cost-effective almost immediately. Aligning with this idea of value-based care, patients get more out of their health care plans with telehealth than ever before. 

 

Telehealth also allows for care to reach anyone who needs it, especially for patients in rural areas or those in other SDOH groups who have typically been disenfranchised in this regard. Individuals in these areas and their health often fall victim to resource gaps, whether it be from lack of health facilities nearby or limitations on transportation. Incorporating telehealth into a provider’s workflow decreases patient no-shows and ensures that a zip code isn’t a barrier to living a healthy life. 

 

Patients who use telehealth, therefore, report high satisfaction rates in their experience and report feeling more informed when continuously connected to their providers. 

 

“For better patient engagement, improving patient-physician communication channels is key as well as incorporating patient portals for faster appointment scheduling and secure messaging capabilities with doctors. This will allow patients to reduce the number of visits necessary while also ensuring they are managing their medical conditions well.”⁴

 

As HEDIS increasingly recognizes the importance of telehealth, it will be best for providers to align their practices accordingly to meet these changing benchmarks.  

 

Sources

¹ “HEDIS” NCQA, https://www.ncqa.org/hedis/

² Carter, Jazmyne. “COVID-19 and Telehealth Expansion.” NCQA Blog, 15 Apr. 2020, blog.ncqa.org/covid-19-and-telehealth-expansion.

³ “Pathway to MACRA’s QPP.” American Academy of Family Physicians, Feb. 2019, www.aafp.org/practice-management/payment/medicare-payment/macra-101/pathway.html.

Gruessner, Vera. “Why HEDIS Quality Measures Matter for Value-Based Care.” Health Payer Intelligence, 1 July 2016, healthpayerintelligence.com/news/why-hedis-quality-measures-matter-for-value-based-care.

 

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