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All That You Need To Know About 2023 HEDIS Measures


The National Committee for Quality Assurance (NCQA) has announced that it will continue publishing the Healthcare Effectiveness Data and Information Set (HEDIS), print-based measures manual, through 2023.

In 2022, the HEDIS measurements for diabetes underwent significant revisions, among other adjustments. Alterations to HEDIS compliance standards are expected to persist throughout the healthcare sector in 2023.

Want to learn about these changes and how to improve your rating this year? Consider the HEDIS audit and read along till the end.

The following outlines the new and revised HEDIS measures for 2023, the HEDIS diabetes measures, making up the HEDIS Comprehensive Diabetic Care plan, and the optimizations that can be made to increase an organization’s HEDIS rating.

What Are HEDIS Ratings?

HEDIS, structured by the National Committee for Quality Assurance (NCQA) in 1991, is widely recognized as the most reliable indicator of healthcare providers’ ability to provide high-quality service to their patients.

Though its primary goal is to advance preventive care, HEDIS has far-reaching implications for the medical field. It helps businesses choose the best coverage and gives healthcare providers insight into where they may improve and where they are succeeding.

Meeting the ever-evolving quality parameters established by HEDIS is crucial for value-based diabetes care providers to achieve a five-star rating and increase bottom-line performance. However, with high rankings comes significant accountability, prompting hospitals and doctors to make concerted efforts to implement preventative measures.

New HEDIS Measures

The following are the official names and descriptions of the newly introduced metrics.

2023 HEDIS Retirements

These new HEDIS metrics were introduced alongside the retirement of some older ones, such as:

Guidelines For Obtaining High HEDIS Ratings

As the healthcare sector and associated technology expand, so do the difficulties faced by providers. In order to adapt to the changing demands of patients, NCQA is constantly updating its standards.

However, HEDIS compliance is likely to become much more challenging in light of a forthcoming white paper from the NCQA that proposes a radical change to diabetes care. In order to maintain competitiveness beyond 2023, the following factors should be considered to enhance HEDIS measures.

HEDIS Measures For Diabetes

Adults with type 1 or 2 diabetes, ages 18-75, who had the following conditions are assessed using the HEDIS Comprehensive Diabetes Care (CDC):

How Can Gaps Be Closed In Diabetes HEDIS Measures?

Integrating IRIS’s diabetic retinopathy screening technology is critical as your company works to achieve and maintain HEDIS compliance. Since diabetes may negatively affect eyesight, regular diabetic retinopathy (DR) checks are recommended for all diabetic patients.

To ensure optimal patient health and provide excellent quality of care, healthcare providers in various settings must be able to easily administer annual diabetic retinopathy exams to diabetic patients, as this is one of the primary HEDIS compliance measures for comprehensive diabetic care.

Thanks to IRIS, any medical facility that treats people with diabetes may provide diabetic retinal exams, eliminating the need for patients to schedule separate appointments for these important preventative checks.

In addition, the licensed eye care professionals at The IRIS Reading Center (IRC) deliver accurate and timely results from diabetic retinopathy exams, giving your business a leg up in the race toward HEDIS compliance for the diabetic eye exam and making care more accessible for your diabetic patients. Curious as to how this might affect the bottom line for your practice, you ask? Here you can test out our return on investment calculator or get in touch with us, and we’ll show you how it works in person.

Top HEDIS Challenges

44% of healthcare providers believe value-based healthcare is good in theory but difficult to implement. Two primary challenges are:

  1. Resource Constraints

NCQA collects HEDIS data from health insurance claims, questionnaires, and provider clinical documentation. Providers may struggle to recruit employees to manage and analyze this data. Statistically:

  1. Disorganized Data Collection

As more healthcare systems digitize, providers must manage more data. More clinical data complicates managing, measuring, securing, and interpreting healthcare data.

Practices collect data inconsistently. Working with providers to switch from paper charts to electronic medical records makes provider chart retrieval and data abstraction difficult (EMR).

Due to resource constraints, healthcare institutions struggle to get providers to release records. These suppliers get data via fax, secure FTP site, EMR, and mail, which presents another problem.

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