Quality Measurement: Paving the Way for Results You can Trust

March 4, 2020 · Matt Brock

Going the extra mile, because it’s the right thing to do.

Most of us have been there. We know it’s a challenge. We know it’s going to take extra time and resources. We know it won’t be easy. But we make the effort anyway, because we know it’s the right thing to do. We know it paves a simpler path for others.

Last fall, we told you about a team working to improve performance measurement and the health care data necessary to improve. The team is made up of a series of organizations that handle health care data. We want to recognize these all-stars for their work and the certification they earned.

We also want to call out two MVP organizations in particular, Inovalon and Interpreta, Inc. Both served as beta-test sites for this challenging year. They took the first round of certification decks and ran additional versions of each measure to ensure that those decks were ready before releasing them to the other organizations seeking certification.

Quality Measurement: Gold Standard Testing

More than three dozen organizations sought NCQA Measure Certification for their software code that delivers measure results. That includes measures related to the Healthcare Effectiveness Data and Information Set (HEDISâ). And in some cases, it includes software that delivers results for the Integrated Healthcare Association’s (IHA) “Align. Measure. Perform.” (AMP) value-based pay-for-performance set of measures.

Here’s why this is important and deserves our admiration: All of them could have taken an easier road. But they held themselves and their systems that handle health care data to a higher standard—the highest standard.

On top of that, this year’s work included some tough new wrinkles to iron out.

Measures Certification: The Workload

We added three new HEDIS measures and five new Electronic Clinical Data Systems (ECDS) measures. That alone means eight new measures to code and certify. We’re just short of 90 measures now. That, my friends, is a lot.

We also added some flexibility in measurement. The new Rules for Allowable Adjustments of HEDIS permit organizations to adjust our base measures to fit their own needs. For instance, they may want to apply the measure to a certain population, different from the population in the HEDIS measure. That’s a significant advancement in flexibility, but also comes with some advanced challenges in terms of validating the software, the data it uses and the logic by which it analyzes the data.

We also added clinical codes that would come in on an Electronic Health Record (EHR). If you’ll remember, much of the performance data is derived from insurance claims, not directly from the record, the EHR, the provider keeps.  So, these organizations again put their best people on the job to test these new data files and adjust the logic—the systems—that will handle them for analysis.

So, why’d they do it? Why’d they take this leap with us? They simply want to make sure that the software works the way it is supposed to. That’s, of course, very important to their bottom line. But passing this gold-standard test benefits all levels of our exceptionally complex health care ecosystem.

The Beneficiaries: All of Us

Payers want accurate results as they make decisions for value-based contracting.

Providers want accurate results to help them respond to their patients’ needs, in a shorter period of time, and with better information.

And patients who compare plans during open enrollment—want to be sure resources like NCQA’s health plan ratings are using accurate measurement results to inform their assessments.

And isn’t that really why we do all this in the first place? For the patients.

NCQA keeps this atop the priority list because we want care to continually and consistently improve. Better measurement and more robust data help drive better results.

So, let’s give this group of organizations a special round of applause.

Congratulations on your NCQA Measures Certification!

We know it wasn’t easy. We know you invested the time and resources to see it through.

It’s also just the right thing to do.



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.




Section background
Section graphic
Section element
Section element
Stay Informed

Get updates, announcements and trending topics

Join 53k+ health care professionals