dQMs: Momentum for Mainstream

July 19, 2021 · Paige Cooke

Digital Quality Summit Track 2: Digital Quality Measurement & Implementation

We asked NCQA’s Public Policy team to report for us from the Digital Quality Summit. They agreed to share what they learned from key sessions.  Paige Cooke, our newly appointed Director of State Affairs, files first:

“Digital Quality Measurement & Implementation” provided an in-depth yet brisk walk through the past, present, and future of digital quality measurement in health care. It showcased the vast opportunities and notable challenges faced with the current and future adoption of digital quality measures, more commonly referred to as dQMs.

The Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) created incentives for healthcare providers to use Electronic Health Records (EHRs). Now, the Cures Act Final Rule of 2021 aims to expand patients’ access to their own electronic health information (EHI). The march to standardize, validate and advance secure sharing of health care data with patients and their chosen providers is on the fast track. Even more, it’s happening across all levels of the healthcare system. It may be a fait accompli by sheer momentum. The question is, how long?

For the quick read, I thought I’d just bullet the highlights. There was a lot to talk about. What are dQMs? How does NCQA use them? Why and how is the quality community aligning to take them mainstream. Here are the highlights.

  • Digital Quality Measures or dQMs:

    • Are specified to use standard interoperability formats so data can be easily shared between electronic systems for Electronic Clinical Data Systems reporting which is a HEDIS reporting standard for health plans that contain a plan member’s personal health information (PHI) and records of their experiences within the healthcare system
    • Use a common data model being adopted by CMS to support the goals of the Cures Act which is the HL7 Fast Healthcare Interoperability Resource also known as FHIR and used to express digital HEDIS measures.
    • Use a standard computable measure logic that is expressed in clinical quality language or CQL so the specifications can be easily understood between electronic systems.
    • Include identifiers and common terminology needed to obtain reliable and comparable data to help in programming the logic expressed in CQL.
  • NCQA will be releasing 22 dQMs in FHIR-CQL for HEDIS MY 2022

    • The new FHIR CQL format includes the measure logic so a vendor has less formatting to do because the calculation is included in the digital quality measure and will be offered for different reporting methods.
    • There were 19 dQMs in the 2019 HEDIS release and the 3 new measures being released for the first time as dQMs are the childhood immunization status (CIS), Continued Risk of Opioid Use (COU), and Follow Up after ED Visit for Mental Illness (FUM)
    • The new HEDIS Schedule Change to the release HEDIS Vol. 1 and 2 in August 2021 will provide measure users an additional 5 months to use them for quality improvement activities in real-time, with a technical update in March of 2022
    • Measure users will be offered the option to purchase the measures in total or in customized bundles to provide more flexibility to pick and choose which measures are of greatest interest or value to their specific work.

Benefits of evolving HEDIS to use more clinical data.

    • Greater insights to foster more specific patient-centered care.
    • Aligns with what is happening in interoperability and supporting more standardization of data as healthcare moves to a more value-based healthcare system that looks at outcomes of care.
    • Decreases measurement burden to exchange data more efficiently in real-time and ultimately get to better and hopefully fewer measures to define quality.

Steps Transforming HEDIS for the Digital Quality System of Tomorrow

    • CMS released a goal for all quality measures being digital by 2025.
    • NCQA plans to evolve the HEDIS measure set by looking at Measure Bundles.
      • NCQA will look at the responsibilities and tools available to address quality at the state, managed care, and provider level, to identify potential measures that tie to each group’s level of accountability.
    • NCQA and other stakeholders can continue to support the adoption and use of dQMs in a number of ways and these are just a few.
    • Quality Stakeholders Continue Exploring Additional Use Case for “Going Digital”
      • Accurate Risk Adjustment
      • Enhanced Care Management
      • Improved Care Coordination
      • Population Health
      • Closing Gaps-in-Care
      • Efficient Patient Outreach
      • Enhanced Provider Communication
      • Reduced Fraud, Waste & Abuse

dQMs standardize quality measurement. Electronic data will be key to develop future quality measures. FHIR-CQL is now THE dQM Standard. The adoption of dQMs has already started. Across six small-to-large HEDIS Certified vendors surveyed—representing 160 million members—17% said their current release includes dQMs, and 67% say they have it on their roadmap. And the ROI? Compared with other options, there’s not a more clear choice. So, dQMs look to be the pick for mainstream implementation. This train is clearly leaving the station.


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