HEDIS 2023 Changes and HEDIS Diabetes Measures

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In 2022, we saw quite a few changes to HEDIS requirements, including the HEDIS measures for diabetes. In 2023, the healthcare industry will continue to experience changes to HEDIS compliance requirements. 

Looking to learn a bit more about these changes and how you can boost your rating this year? Keep reading! Detailed below are the additions and changes of the 2023 HEDIS measures, along with a list of the HEDIS measures for diabetes that make up the HEDIS Comprehensive Diabetic Care plan, followed by a few optimizations organizations can make to boost their rating.

What are HEDIS Ratings?

Introduced in 1991 by the National Committee for Quality Assurance (NCQA), the Healthcare Effectiveness Data and Information Set (HEDIS) is now the gold standard for measuring quality healthcare performance. 

Primarily focused on improving preventative care, HEDIS offers a myriad of benefits to the healthcare industry as a whole. It allows employers to determine the best coverage options while equipping healthcare systems to identify which areas of their systems need optimization and which are excelling. 

For value-based diabetic care providers, complying with the ever-changing quality measures set in place by HEDIS is critical to meeting a five-star rating and boosting bottom-line performance. But with great ratings comes great responsibility, spurring an active effort for health systems and providers to integrate preventative systems into their practices.

If you’re looking for the entire HEDIS 2023 volume, click here to read more.

2023 HEDIS Changes 

To remain relevant to growing healthcare issues, the NCQA updates HEDIS annually. In 2022, the NCQA made several updates, including the addition of three new measures, the removal of three measures, the amendments of seven existing measures, and two cross-cutting topics. While there were many changes, we are specifically covering the changes that pertain to comprehensive diabetic care. 

Here are the new HEDIS measures to be aware of in 2023:

  1. Pediatric Dental Care

NCQA added measures to improve the oral evaluation and dental service of individuals receiving Medicaid who are under the age of 21. 

  1. Deprescribing of Benzodiazepines in Older Adults

NCQA recommends deprescribing benzodiazepines in adults over 67 years of age slowly and gradually rather than stopping use immediately in order to avoid withdrawal symptoms.

  1. Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes

This measure attempts to better protect elderly individuals with diabetes who are at a greater risk of developing hypoglycemia.

  1. Social Need Screening and Intervention

NCQA developed screening processes for various food, housing, and transportation insecurities in order to advance health equity in the US.

2023 HEDIS Retirements

Along with these added HEDIS measures came the retirement of a few others, including:

  1. Annual Dental Visit
  2. Frequency of Selected Procedures
  3. Flu Vaccinations for Adults Ages 18-64, 65 and Older, and Pneumococcal Vaccination Status for Older Adults (PNU)

Why is HEDIS Compliance Important to Providers?

HEDIS compliance is important to providers for a number of reasons, including:

  • Use as a tool to ensure effective care for patients
  • Assistance in identifying gaps in patient care
  • Generation of additional revenue that providers can earn through Pay for Quality, Value Based Services, etc.

Top HEDIS Challenges 

From the standpoint of a  provider, meeting HEDIS measures is difficult to achieve. In fact, 44% of providers think value-based healthcare is a good idea in theory, but very hard to execute in practice. This is due to two main challenges:

1. Lack of resources

The NCQA collects HEDIS data using health insurance claims, surveys, and clinical documentation submitted by providers. This requires a great deal of database management, and providers can have a difficult time finding proper staff to manage and understand this data. Statistics show that:

    • 32% of providers find busywork like EHR data entry to be the biggest frustration. 
    • 47% have difficulty reporting and collecting quality metric data and 34% have a hard time training staff to understand it. 
    • Insurers and providers routinely lack IT support, making it difficult to collect data required for HEDIS quality measures. 

2. Disorganized data and collection

With an increase in the amount of healthcare systems undergoing a digital transformation, the sheer amount of data providers have to manage has increased significantly. With more clinical information available, providers are facing more complexities in terms of managing, measuring, securing, and analyzing healthcare data. 

Additionally, data collection is inconsistent across practices. Provider chart retrieval and abstraction of data is a complex process, especially when working with providers to move from paper charts to electronic medical record systems (EMR).

For healthcare systems, getting providers to respond and release records upon request is a challenge and is likely due to their lack of resources. Another challenge is the sheer number of formats data is sent in to these providers, including fax, secure FTP site, EMR, or traditional mail. 

Considerations for Achieving High HEDIS Measures 

Challenges continue to rise for providers as the healthcare industry and its technology is growing rapidly. As the world evolves, NCQA continues to do so to keep up with patient needs.

In fact, a new white paper by the NCQA suggests a complete diabetes care overhaul, which will only make HEDIS compliance more complicated. For practitioners to remain competitive going into 2023 and beyond, below are some considerations to help improve HEDIS measures: 

  • Integrate continuous glucose monitoring (CGM) as a quality performance metric
  • Provide educational information and resources to help support patients with behavioral health and social needs to improve outcomes
  • Promoting responses to diabetes distress with screenings, assessments, and timely intervention 
  • Consider incorporating a retinal imaging device in-house if you’re a center that interacts with diabetic patients frequently, where you can get results interpreted by a board-certified optometrist or ophthalmologist quickly and effectively (read more about this type of solution here)
  • Evaluate and document HbA1C every 3-6 months
  • Automate alerts in your EHR to remind staff to follow up with patients due for care


What are the HEDIS Measures for Diabetes?

The HEDIS Comprehensive Diabetes Care (CDC)  evaluates adults ages 18-75 with type 1 or type 2 diabetes who had the following:

  • Hemoglobin A1c (HbA1c) testing
  • HbA1c poor control (>9.0%)
  • HbA1c control (<8.0%)
  • Eye exam (retinal) performed
  • Medical attention for nephropathy
  • BP control (<140/90 mm Hg)

How to Close Gaps in Diabetes HEDIS Measures

As your organization seeks solutions to help improve its HEDIS compliance, IRIS’s diabetic retinopathy screening solution is a vital tool to integrate into your organization. Diabetic retinopathy (DR) exams are necessary to monitor the eye health of diabetic patients because of the significant impact diabetes can have on a patient’s vision. As one of the primary HEDIS compliance measures for comprehensive diabetic care, ensuring that staff across different healthcare settings can easily administer annual diabetic retinopathy exams to diabetic patients is key to optimal patient health and providing an excellent quality of care.

IRIS enables any healthcare center that interacts with diabetics to do just that by providing the capabilities to perform diabetic retinal screenings, reducing the need for patients to book multiple preventative screening appointments aside from their regular doctors visits.

In addition, The IRIS Reading Center (IRC) is composed of licensed eye care providers who provide comprehensive and thorough diabetic retinopathy exam results quickly, allowing your organization a heightened ability to achieve HEDIS compliance for the diabetic eye exam while providing more convenient care for your diabetic patient population. Curious to learn more about how this could impact your practice’s bottom line? Try out our ROI calculator here, or reach out to us so we can show you how it works first-hand.


What is a HEDIS Compliance Audit?

A HEDIS audit assesses whether or not an organization has the ability to process medical, member, and provider information as a foundation for accurate and automated performance measurement. In summary, it’s an audit for the organizations that will be performing the HEDIS surveys for healthcare organizations, which will be collected by the NCQA and evaluated.

What are Reasonable HEDIS Compliance Targets for a Primary Care Audience?

Providers should always strive to receive “excellent” HEDIS compliance scores. An excellent HEDIS score will be a high average of ratings in these six domains of care:

    • Effectiveness
    • Availability
    • Experience
    • utilization/risk-adjusted utilization
    • Health plan descriptive information
    • Measures reported using electronic clinical data systems

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