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NCQA’s HEDIS measures have ensured health care quality for more than 30 years, and now, 191 million people—over half the U.S. population—are enrolled in an NCQA-Accredited health plan that reports on these vital measures.
Historically, health plans have had to translate HEDIS measures into computer code that extracts specific information.
· The issue: Individual coding of HEDIS measures means that organizations may interpret measures differently, leading to improper or inconsistent coding and diminishing the ability to compare health information across organizations.
· The solution: NCQA’s measures for digital reporting. These measures allow both health care professionals and computer systems to understand their specific intent.
Some states, such as Pennsylvania and New Jersey, have launched large-scale digital measure implementation while also tackling a nationwide health concern: the opioid epidemic.
Pennsylvania used several techniques to adopt digital measures:
· Leveraged its contracts with Managed Care Organizations (MCOs) to require reporting measures in NCQA’s ECDS (Electronic Clinical Data Systems).
· Used grant funding to onboard providers with health information organizations (HIO) to enable robust electronic quality measure extraction.
· Required MCOs to contract with HIOs and develop digital quality measurement strategies.
· Created value-based incentive programs that encourage digital quality measurement.
Pennsylvania’s Opioid Hospital Quality Improvement Program focuses on providing treatment for people seen in the emergency department (ED )for opioid use disorder (OUD). The program incentivized EDs to develop pathways for OUD treatment, while also holding them accountable for transmitting information about admissions, discharges and transfers (ADT) to their HIO. While it was once rare for EDs to develop these pathways or transmit ADT information, many now do both. With a new level of data fullness and transparency, HIOs can now measure ED follow-ups for OUD.
New Jersey’s Approach
New Jersey began tackling the opioid crisis while also advancing its digital measure infrastructure.
· In 2017, the Centers for Medicare & Medicaid Services (CMS) approved New Jersey’s waiver to test new methods for delivering and paying for substance use disorder (SUD) treatment, with the requirement of a SUD health IT plan.
· In 2018, New Jersey Governor Phil Murphy budgeted $6 million for health IT to address the opioid epidemic.
· In 2019, the EHR Incentive Program was launched (now the Promoting Interoperability Program), with a goal for efficient reporting and sharing of health care data.
Organizations must meet five milestones to receive incremental incentive payments. This approach differs significantly from traditional program implementation efforts that provide full grant funding up front and enabled New Jersey to tackle the opioid crisis while simultaneously implementing key digital measurement infrastructure that increases care coordination and quality among formerly siloed health care systems.
Digital measures are key to NCQA’s effort in improving quality measurement, encouraging exchange of health information and promoting quality improvement via digital enablement. NCQA intends to release digital adaptations of existing measures over time, but for now, consider adopting the NCQA HEDIS measures currently in digital form to achieve results similar to Pennsylvania and New Jersey.
As more organizations adopt digital health measures, we must highlight their journey and their successes in this space.
Tyrek Shepard | Product Management Intern, Product Design & Support | NCQA
Tyrek Shepard is a Product Management Intern in the Product Design & Support Department at the National Committee for Quality Assurance (NCQA). His summer activities have primarily focused on digital quality measurement, while also supporting multiple health equity initiatives.
Tyrek is currently a graduate student at the Georgia Institute of Technology pursuing his Master of Science in Public Policy and earned his Bachelor of Science in Accounting from North Carolina State University. His research interests include social policy, healthcare policy, social determinants of health, and policy issues related to minority populations.