Everything You Need to Know About 2022 HEDIS Measures & Compliance

DRS Plug Retinal Camera

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 and healthcare systems learn which areas of their system 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.

In this post, we will cover everything diabetic care providers need to know about improving HEDIS quality measure performance. 


2022 HEDIS Changes Regarding Diabetes 

Diabetes is a persistent issue in the American healthcare system. 37.3 million Americans—about 1 in 10—have diabetes, and another 96 million American—more than 1 in 3—have prediabetes 

Diabetes Infographic

Source: Centers for Disease Control (CDC.gov)

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 2022:

1. Changes to existing HEDIS measures:

NCQA changed the following existing measures: comprehensive diabetes care/Hemoglobin A1c control for patients with diabetes, eye exam performed for patients with diabetes, and blood pressure for patients with diabetes. 

2. Updates to cross-cutting topics: 

NCQA introduced race and ethnicity stratifications to five HEDIS measures including colorectal cancer screening, controlling high blood pressure, Hemoglobin A1c control for patients with diabetes, prenatal and postpartum care, and child and adolescent well-care visits. To help reduce disparities in care among patient populations, the NCQA plans to expand the race and ethnicity stratifications to additional HEDIS measures over the next few years. 

3. Retirement of standards:

The NCQA removed the comprehensive diabetes care—HbA1c testing indicator. Instead, it will concentrate efforts on the outcome-based HbA1c control for patients with diabetes. 


Top HEDIS Challenges 

HEDIS has made great strides in helping consumers compare multiple health plans and local medical facilities based on their excellence in patient care. But 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, 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 (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 the organization enforce a complete diabetes care overhaul which will only make meeting HEDIS compliance more complicated. For practitioners to remain competitive in 2022 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 precision responses to diabetes distress with screenings, assessments and timely intervention 
  • Either refer patients to an optometrist or ophthalmologist for annual retinal eye exams, or if you’re a center that interacts with diabetic patients frequently, consider incorporating a retinal imaging device in-house where you can get results interpreted by a board certified optometrist or ophthalmologist quickly and effectively
  • Evaluate and document HbA1C every 3-6 months
  • Automate alerts in your EHR to remind staff to follow up with patients due for care


Conclusion: Use IRIS for HEDIS Compliance

As your organization seeks solutions to help improve its HEDIS compliance, IRIS 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 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.



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