HEDIS® is Going Digital
March 9, 2022 · Matt Brock
NCQA aims to make all HEDIS measures digital in five years.
The Case for Digital
By digital measures, we mean measures that NCQA writes and provides as computer code.
A digital approach is a welcome alternative to the traditional model of “paper-based” measures. Traditionally, NCQA publishes HEDIS measures in thick books or e-pubs. Hundreds (or thousands!) of people at organizations that use HEDIS then read, interpret and manually enter those measures into their IT systems. That process is laborious and duplicative. It also invites human error and unwarranted variation.
Benefits of digital measures include:
- Ease: Faster implementation, lower programming costs, less human error—digital measures’ many advantages combine and compound to make them easier to use.
- From Measurement to Improvement: NCQA’s main contribution to health care for more than 30 years has been measuring health plans’ quality. We want to build on that heritage by enabling improvement at different levels of health care. Digital measures’ blend of standardization and flexibility can help us do that.
- Utility at the Point of Care: Making measures useful in the delivery system means two main things. First, it means expanding the —something our allowable adjustments have started to do. Second, greater utility at the point of care means building measures using data collected at the point of care.
How We’ll Get There
Our plan for digitalizing HEDIS, nicknamed our Measures Roadmap, has three related pieces:
- Better Data: By better data, we mean moving beyond administrative claims and leveraging more standardized electronic clinical data for measurement. Standardized measure calculations, provided digitally, will support more sophisticated measures that use better data.
Digitalizing HEDIS took a big step forward when we released 22 FHIR/CQL digital measures last year. (For information about the FHIR and CQL data standards, see the slides, transcript or recording of Episode 5 in our webinar series: FHIR in Our Future.)We will keep converting some measures to a digital format each year using FHIR/CQL standards. For some measures that rely on claims data and medical record review, going digital will mean first improving them to leverage electronic clinical data.
- Better Measures: By “better measures,” we mean leveraging more and better data will help us measure what matters most—clinical outcomes and patient-centered care.Traditionally, the main way to evaluate hard-to-measure areas (managing chronic conditions, for example) has been to count visits and study care processes. These measures will always have a role. But measures that are patient-centered and tied to outcomes present the biggest opportunity to advance quality and value.Because better measures will help us close care gaps, they can help improve health equity. Better measures will also make it possible to address areas that we haven’t been able to measure before, such as addressing social determinants of health.
Many quality programs use existing measures. That means introducing better measures will have to be a process, not an event. We will use public comment and transition periods to carefully replace existing measures with better ones.
- Better Alignment: By better alignment, we mean measurement that supports myriad levels of the health care system, not just health plans. Ensuring that measurement serves multiple accountable entities means making sure measures are:
consistent (so the structure and logic of a measure mirrors that of the measure at the next level);
connected (so calculations “roll up” from one level to the next); and
driving care improvement (because measurement isn’t the goal, better care is).This “drive to align” also relates to what we mentioned above under From Measurement to Improvement: Expanding beyond our traditional focus on health plans will help improve care throughout health care system.
Caveats & Adjustments
- It’s Five-ish: Our plan for HEDIS to be all digital in 5 years is a general schedule, not an ironclad timeline pegged to a particular day or month. We want to move briskly and with purpose. But we’d rather do it right than rush to meet deadlines for the sake of meeting deadlines.
- Details Depend on Your Feedback: Input from outside NCQA—including the HEDIS Public Comment that closes Friday, March 11—will shape how and when HEDIS evolves. Developing HEDIS measures is consensus-based. The mantra, “Nothing about me without me” applies. As NCQA President Peggy O’Kane said to HEDIS users during the webinar, “Our commitment to you is to work with you to make this work. And we ask you for the same.”
The Bottom Line
To make quality measurement a cornerstone of health care’s digital future, HEDIS is evolving to:
- Standardized measure calculations that leverage better data.
- Assess more meaningful concepts with better measures.
- Support more levels of the health care system and more use cases for quality measurement through better alignment.
This evolution will be gradual and will give HEDIS users many opportunities to give feedback.