Delayed care. Digital measures. How health plans can navigate the new quality landscape successfully.
Health Plans

Improving Quality Measures: Post-Pandemic

April 8, 2021
Delayed care. Digital measures. Navigate the new quality landscape successfully.
Chief Product and Client Officer


It is beyond an understatement to say that a lot changed last year. But it did. Now it’s time for health plans to look ahead to identify quick-win members for outreach, enhance reporting to gauge efficacy, and take steps to implement digital strategies.

One AHIP study broke down the pandemic's impact on HEDIS measures.

Only time will reveal the full ramifications of the pandemic on National Committee for Quality Assurance (NCQA) HEDIS® quality measures. However, a recent study dove deep into each of the 89 HEDIS® measures for 2020 to determine the most likely impacts.

According to the study, nearly three-quarters (74 percent) of measures are likely to experience moderate to high performance decrease, driven by the dramatic reduction in outpatient/ambulatory care coupled with delayed preventive care services.

Conversely, 15 percent of measures are likely to experience moderate to high performance increases. Top drivers include risk-adjusted utilization domains and the unprecedented adoption of virtual healthcare.

The study anticipates experience-based measures to have marginal performance variation, leaving 11 percent of measures unaffected. 

Delayed care impact: Moderate to high performance decrease

National shutdowns in early 2020 brought preventive screenings, access to care and key immunization events to a standstill. There is improvement across the board as restrictions ease and people return to normal care. However, the long-term impacts are deeply worrisome.

Take cancer screening for example. Epic Health Research Network revealed an 86 to 94 percent drop in preventive cancer screenings early 2020. June showed improvement, but remained substantially below 2019 rates. For quick-growing cancers, a delayed diagnosis is dangerous and may result in more advanced diagnoses and worsened outcomes. In fact, the National Cancer Institute predicts at least 10,000 excess deaths from breast and colorectal cancer alone over the coming year or two as a direct result of deferred preventive screenings and deferred regular in-person exams. 

It gets worse. People most in need of care – those with multiple chronic conditions -- are the ones most likely to delay or forego care completely according to a study from the Urban Institute.

The physical health conditions most commonly reported by adults with delayed or forgone care include some of the nation’s most costly chronic conditions such as obesity, diabetes, hypertension, heart disease and cancer.

Widespread delayed care for people with chronic conditions is likely to put health plan quality initiatives at risk for several years across several quality measures.

Widespread delayed care for people with chronic conditions is likely to put health plan quality initiatives at risk for several years, most notably across quality measures focused on diabetes, cardiovascular, musculoskeletal, respiratory and mental health.

To help offset ongoing and future consequences of deferred care, health plans are advised to take advantage of the current pause on HEDIS® data submission to focus resources on the identification of and outreach to members most at risk. As researchers note, one key strategy for regaining quality momentum is to optimize outreach through data science:

Enable data-science-driven, high-value population cohorts that require minimum cost of intervention, with propensity to yield maximum compliance outcome.

Enable data-science-driven, high-value population cohorts that require minimum cost of intervention, with propensity to yield maximum compliance outcome.

Recently, a regional health plan used this strategy and combined next-generation predictive analytics with their in-house advanced case management model to identify and focus efforts on members with chronic conditions who were most likely to experience complications within the next 12 months. 

Digital health impact: Moderate to high performance increase

COVID-19 revealed significant weaknesses in the usual processes of collecting quality data. Most notably in-person data from providers during typical chart reviews. This disruption triggered the NCQA to put a pause on HEDIS® data collection.

According to Frank Micciche, vice president of public policy and external relations at NCQA, one way to prevent such a disruption in the future is the further expansion of digital quality measures. Digital strategies for data collection and reporting ease the administrative burden on health plans and providers by using data pulled from sources such as EHRs, HIEs and other registries instead of business-as-usual chart chasing.

In addition to digital data collection and reporting, telehealth-based quality measures are expected to be a significant portion of the 15 percent of quality measures positively impacted by the pandemic.

The sudden rise in popularity of digital strategies prompted the NCQA to make sweeping changes to allow telehealth accommodations across 40 HEDIS® quality measures. 

It’s no secret that telehealth has been gaining popularity with members, providers and health plans alike over the past several years. However, adoption has been relatively slow up until COVID-19 lockdowns triggered rapid expansion. PwC’s Health Research Institute predicts telehealth utilization is likely to “remain up over pre-pandemic levels” and encourages insurers to evaluate national and regional telehealth platforms to support growing demand. 

Telehealth itself is just the beginning of digital health experiences. Consumer preferences and market forces suggest digital strategies such as the digital front door will play a key role in driving member engagement, satisfaction and loyalty over the next few years.

The time has never been better for health plans to invest in digital strategies to meet the current and expected future needs of their members and of the healthcare ecosystem at large. Industry experts agree:

  • As Rock Health wrote, “The COVID-19 pandemic has created unprecedented demand and urgency around the shift to digital content, navigation and delivery of healthcare.”
  • Summer Knight, MD, managing director, Deloitte Life Sciences & Healthcare Practice, said in a PatientEngagementHIT article, “The digital front door is going to create a longitudinal relationship built with trust between patient and provider, and inherently moves away from the old model of sick-care.”

To optimize the 15 percent of HEDIS® measures expected to see a positive impact from the pandemic, health plans are advised to ensure the proper coding of all virtual care. Further, insurers looking to establish a competitive advantage and increase member engagement should take steps to implement comprehensive digital data collection strategies and personalized digital member journeys.