- Summary of key changes: The proposed changes to the 2025 HEDIS Blood Pressure Measure include broadening the criteria for hypertension diagnosis, introducing a new blood pressure target (<130/80 mm Hg), and transitioning to an Electronic Clinical Data System (ECDS) reporting method, replacing the current hybrid measure.
- Why this matters for health plan administrators: These changes enable more inclusive identification of patients with hypertension and align with evolving clinical guidelines for blood pressure control. In addition, embracing the transition to an ECDS reporting method facilitates interoperability and helps to reduce the challenges associated with collecting blood pressure readings from providers.
The National Committee for Quality Assurance (NCQA) has recently proposed major changes to the Healthcare Effectiveness Data and Information Set (HEDIS®) measure for Measurement Year (MY) 2025 Blood Pressure Control for Patients With Hypertension (BPC-E) and is seeking public comment. The draft measure broadens the criteria for those diagnosed with hypertension and is an electronic clinical data systems measure that would replace the current hybrid Controlling High Blood Pressure (CBP) measure.
Why does this matter? Because effectively managing high blood pressure is a crucial step in preventing serious heart-related issues and mortality. Below, we’ll examine the key changes proposed and explain what they mean for your business.
Modification # 1: Expanded Denominator
The current method of identifying people with high blood pressure requires at least two claims-based diagnoses of hypertension within an 18-month period. The proposed change allows for the use of pharmacy data to confirm the diagnosis. This change would expand the CBP denominator, allowing health plans to capture a wider, and more accurate, range of patients with hypertension.
Modification # 2: Expanded Numerator
In recent years, clinical organizations like the American College of Cardiology and the American Heart Association have been modifying their guidelines to reflect a more aggressive stance on blood pressure control. The draft measure aligns with these guidelines by incorporating a BP level of <130/80 mmHg as an additional target during the measurement period. Evidence shows that a lower blood pressure target ultimately results in fewer cardiovascular events, resulting in significant cost savings for health plans.
Modification # 3: Electronic Clinical Data System (ECDS) Reporting Method
The current CBP measure allows plans to report using either administrative-only data or administrative data supplemented with medical record review, i.e. the Hybrid Method. The proposed measure transitions away from the Hybrid Method by using ECDS reporting. This reporting method includes data sources such as administrative claims, electronic health records, case management, and health information exchanges.
Removing medical record review can alleviate reporting burden and facilitate the transition to fully digital measures. This aligns with The Centers for Medicare & Medicaid Services’ direction and promises long-term benefits, such as reducing provider burden and enhancing patient risk identification. The change would also align with the broader industry trend towards digitization and interoperability, ultimately increasing efficiencies.
Embracing Progress and Encouraging Action
NCQA is accepting comments for the draft measure until 5 pm ET on March 13. As healthcare management professionals, your voice holds significant weight in shaping the trajectory of future quality measures. This public comment period gives you an opportunity to advocate for better blood pressure control to reduce risk of cardiovascular events and mortality.
We urge administrators to carefully consider the proposed changes. By supporting NCQA's proposal, you contribute to a healthcare landscape that aligns with evolving clinical standards, improved health outcomes, and modern data management practices. Let’s embrace progress, advocate for change, and collectively contribute to a system that continuously evolves to meet the needs of our patients and members.
Reach out to us if you’d like to learn more about the proposed changes and how you can prepare for them now.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
1. Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed October 19, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https:/www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed October 19, 2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.
2. Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021- Final.pdf. Published October 2021. Accessed October 19, 2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-fundedemployer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)
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