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New opioid use measure added to health plan data set

July 03, 2018

The 2019 edition of the National Committee for Quality Assurance's (NCQA's) performance measurement set for health plans will include a new measure designed to evaluate plan members' risk of problematic opioid use.

The Risk of Continued Opioid Use measure in the Healthcare Effectiveness Data and Information Set (HEDIS) will calculate the percentage of adult plan members who have a new episode of opioid use that puts them at risk for continued use. Two rates will be reported under the measure: the percentage of members whose new episode of opioid use lasts as least 15 days in the past 30 days, and the percentage whose new episode lasts at least 31 days in the past 62 days.

NCQA states in the intent language for the measure's inclusion in HEDIS, “Continued opioid use for noncancer pain is associated with increased risk of opioid use disorder, opioid-related overdose, hospitalization and opioid overdose-related mortality.”

NCQA has released new technical specifications for the 2019 edition of HEDIS, used by more than 90% of the nation's health plans as a performance measurement and benchmarking tool. HEDIS data also are used by employers and consumers in the evaluation of health plans.

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