Highlighting Health Plans that Leverage Electronic Clinical Data

October 12, 2022 · NCQA Communications

NCQA has long emphasized the importance of quality by publishing health plan performance on HEDIS measures through its programs like Quality Compass and Health Plan Ratings. To highlight health plans that are leveraging electronic clinical data, NCQA introduced a distinction on our Health Plan Report Cards which identifies health plans using the HEDIS Electronic Clinical Data Systems (ECDS) Reporting Standard. This reporting standard facilitates the use and sharing of relevant electronic data across health care systems. Importantly, it allows for greater assessment of person-specific outcomes, more real-time results and improves the value of information used to assess quality.

Why did NCQA Create the Electronic Clinical Data Distinction?

While much progress is being made to improve the availability and usability of electronic clinical data for quality measurement and care improvement, challenges remain. Health plans are at different stages of readiness for leveraging clinical data and we recognize it takes time to shift resources to capturing and sharing information electronically. Therefore, NCQA’s strategy has been to introduce measures for optional reporting and slowly phase measures into public reporting status. During this transition we wanted to highlight those health plans that are going the “extra mile” to report new and sometimes challenging quality measures.

What is the Electronic Clinical Data Distinction?

This distinction highlights organizations that reported quality measures that leverage electronic clinical data. Using and sharing clinical data will enrich the information available to patients, providers, and health plans. Measures that leverage clinical data captured routinely during care delivery can also reduce burden on providers to collect data for quality reporting.

To earn the distinction, organizations needed to report a performance rate of greater than zero for at least one of the seven not yet publicly reported measures that were originally introduced for the HEDIS ECDS Reporting Standard. In 2022, these measures focus on behavioral health screenings and follow-up, depression management and receipt of recommended immunizations for adults. Full details of the distinction criteria are found in NCQA’s Report Card Glossary. As NCQA continues to introduce new quality measures for the ECDS Reporting Standard, and as these measures move to public reporting status, we will consider updating the distinction criteria accordingly.

Going Beyond Recognizing Reporting

With sufficient improvements in organizations’ ability to report, NCQA intends to use results for assessing quality and evaluating performance. NCQA’s 2022 (Measurement Year 2021) Health Plan Ratings includes the Prenatal Immunization Status measure as the first ECDS-reported measure included in the program. Consumers and businesses can now use the Ratings to understand which health plans are ensuring their members receive recommended immunizations during pregnancy. A special congratulations to the Medicaid and commercial plans that received a 4-star rating or above on this important quality measure in 2022! Please visit NCQA’s Health Plan Ratings to view performance for individual organizations.

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