Measure Certification: Together. Better.
October 1, 2019 · Matt Brock
Quality improvement is a team sport, and we have the team to prove it. The key players on our team? Organizations who handle all that health care data.
More than three dozen organizations will seek NCQA Measure Certification for software code that delivers measure results. That, of course, includes measures related to the Healthcare Effectiveness Data and Information Set (HEDIS®). And in some cases includes software that delivers results for the Integrated Healthcare Association’s (IHA) “Align. Measure. Perform.” (AMP) value-based pay-for-performance set of measures. New to the sport this year is certification that accounts for Rules for Allowable Adjustments of HEDIS so that different levels of the health care system can use HEDIS measures.
Measure Certification: The Lineup
Why does this matter? To keep it simple, NCQA and these vendors want to make sure that the software works the way it is supposed to. That’s important on all levels of the nation’s complex health care ecosystem. Important to payers, providers, even patients.
Payers especially want accurate results as they make decisions for value-based contracting, not to mention the time saved by eliminating the manual source-code review part of a HEDIS Compliance Audit or an AMP Audit Review.
Providers want accurate results to inform them of best practices in treating patients. And patients—who may compare plans during open enrollment—want to be sure resources like our health plan ratings compile their assessment with accurate results.
Measure Certification: Team Captains
All of these organizations will test their software using HEDIS 2020 and AMP measures. That way, we know it’s ready for the here and now.
You could say two organizations are really serving as the captains of our team. Inovalon and Interpreta, Inc. are this year’s beta-test sites. That means they’re taking the first round of our certification tests for 2020 to to help us prepare for the rest of the team.
Which brings us back to our statement: Quality Improvement is a team sport.
Measure Certification: The Victors
Let’s put it in a baseball metaphor. Check out our “roster.” These organizations are our lead-off hitters, loading up the bases. Now with certified results, plans and providers are better suited to score homeruns. Patients get the big win with improved care.
HEDIS® is a registered trademark of NCQA.
HEDIS Compliance AuditTM and AMP Audit ReviewTM are trademarks of NCQA.
NCQA Measure CertificationSM is a service mark of NCQA. All rights reserved.