HEDIS updates

The Healthcare Effectiveness Data and Information Set (HEDIS^®)* helps ensure timely and appropriate patient care and helps you identify gaps in care for your patients with chronic and acute illnesses. HEDIS provides valuable information on public health trends and at-risk groups, which can help improve your patients’ outcomes and support the delivery of value-based care.

Kidney Health Evaluation for Patients with Diabetes measure – new

This measures the percentage of customers ages 18‒85 with diabetes types 1 and 2 who received a kidney health evaluation — defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR) — during the measurement year. This measure is moving to Stars in 2024 with single weighting.

Provider action tip: This replaces the old diabetes measure for kidney evaluation. New lab tests will be required.

Care for Older Adults Functional Status Assessment measure – returning

This measures the percentage of adults age 66 and older who had each of the following performed during the measurement year:

• Medication review
• Functional status assessment
• Pain assessment
• Removing hybrid reporting for Colorectal Cancer Screening and transition to Electronic Clinical Data Systems (ECDS) Reporting 
• Updating denominator eligibility criteria for diabetes measures (A1c Control, Eye Exam, Kidney Health Evaluation) to: 
  • Two diagnoses of diabetes during the measurement year or year prior
    OR
  • Dispensed Insulin or hypoglycemics/antihyperglycemics during the measurement year or year prior with one diagnosis of diabetes during the measurement year or year prior

Pain and medication reviews are Star measures with a single weight, and functional status assessment is moving to Star measures in 2024 with a single weight.

Provider action tip: Review our provider guide “How to Close Care of Older Adults Gaps” for information and options for closing gaps. This and other Stars-related tools are available at MedicareProviders.Cigna.com > Provider Education & Assessment Tools > Stars Education.

Complete and accurate documentation: Cigna Healthcare resources for your practice

The Centers for Medicare & Medicaid Services (CMS) announced the final rule for Medicare Advantage plans on March 31, 2023. Modifications to the risk-adjustment program will be phased in over three years.

Cigna Healthcare offers convenient webinars, disease-specific education, guides, tools, and resources, to help you:

• Stay current on the latest trends in chronic condition prevention and treatment.
• Streamline and support complete, accurate, and precise medical record documentation and coding.
• Reduce administrative burden.
• Make your practice more efficient and effective.
• Earn free continuing medical education credits.

Part D Updates

Updating Med Adherence for Diabetes Medication, Hypertension (RAS Antagonists), and Cholesterol (Statins) to implement continuous enrollment instead of member year calculation for the denominator.

Health Outcomes Survey (HOS) Updates

• Addition of Improving or Maintaining Mental
  Health at 1x weighted
• Addition of Improving or Maintaining Physical
  Health at 1x weighted

CAHPS Updates

• Reducing the weight of patient experience/complaints and access measures from 4x to 2x
• Implementing web-based mode for the 2024 CAHPS
  survey

* HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).