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Frequently Asked Questions Insurance

Does OPM permit Hybrid and Administrative HEDIS metric collection?

OPM permits the use of either hybrid or administrative data collection, where applicable per measure specifications, for metrics reported to NCQA. For HEDIS 2013, we asked carriers to refrain from switching data collection methodologies while we implemented a new OPM scoring system. For HEDIS 2014, all carriers are encouraged to utilize hybrid data collection for all measures where NCQA provides this option and it is applicable to the reported product.

While we will continue to accept the use of only administrative data collection, we believe the hybrid data collection method will allow more complete data capture. If expenses associated with hybrid data collection cannot be accommodated within a plan’s projected expense limit for HEDIS 2015, an explanation and cost justification should be submitted along with the administrative expense limit proposal.

Metrics collected via the administrative methodology only include: Breast Cancer Screening (BCS), Follow-up After Hospitalization for Mental Illness (FUH), Plan-All Cause Readmissions (PCR), Ambulatory Care Emergency Department Visits (AMB-B), Medication Management for People with Asthma (MMA), Use of Imaging Studies for Low Back Pain (LBP), Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB), and Well-Child Visits in the First 15 Months of Life (W15).

Metrics collected via the administrative or hybrid methodologies include: Cholesterol Management for Patients with Cardiovascular Conditions LDL-C Screening (CMC), Comprehensive Diabetes Care Hemoglobin A1c Testing (CDC), Comprehensive Diabetes Care LDL-C Screening (CDC), Prenatal and Postpartum Care - Timeliness of Prenatal Care (PPC), and Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC).

Metrics collected via the hybrid methodology only include: Controlling High Blood Pressure (CBP).

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