HEDIS 2020 New Measures Update


Under the direction of Governor Gavin Newsom, the Department of Health Care Services (DHCS) recently notified Medi-Cal managed care health plans of the new Quality Measures that are required to be reported in 2020 (measurement year 2019). The measures are aligned with the Centers for Medicare and Medicaid Services (CMS) Child and Adult Core sets. The Child and Adult Core sets are available for reference at medicaid.gov/medicaid/quality-of-care.

The Alliance has already been focusing on several of these measures, and has identified an area of improvement for members zero to three months of age. Specifically, some Alliance members are not accessing care, including important well child visits. The Alliance will be partnering with our network of providers to encourage members to schedule and attend these visits on time, along with developmental screenings and immunizations in alignment with Bright Futures guidelines (brightfutures.aap.org).

As part of this partnership, the following measures have been added to the 2020 Care-Based Incentives (CBI) program. In addition, the Alliance is in the process of developing a campaign to support providers in encouraging members to bring their infants in for their well-visits. The following measures are among those added to CBI 2020.

  • Childhood Immunizations changing to Combo 10 – this measure now requires additional vaccines (see list below) to be completed by the child’s second birthday
    • 4 diphtheria tetanus, acellular pertussis (DTaP)
    • 3 inactivated polio vaccine (IPV);
    • 1 measles mumps and rubella (MMR)
    • 3 Haemophilus influenzae type B (HiB)
    • 3 Hepatitis B (HepB)
    • 1 varicella (VZV)
    • 4 pneumococcal conjugate (PCV)
    • 1 chicken pox (VZV)
    • 2 or 3 rotavirus (RV)
    • 1 hepatitis A (HepA)
    • 2 influenza (flu)
  • Well-Child Visits in the First 15 Months of Life (W15)
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents (WCC)– BMI Assessment
  • Developmental Screenings in the first three years

Please email the Alliance’s Quality Improvement department if you have any questions regarding the HEDIS 2020 or CBI 2020 measures at [email protected] or call an Alliance Provider Relations Representative at (800) 700-3874, ext. 5504.