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COVID-19 has laid bare many issues in the health care system—but it’s also been a catalyst for real change and transformation. Ideas that were adaptable, but slow moving, are being reexamined. The pace of adaptation has accelerated.
The global pandemic, federal guidance and state innovation spearheaded an appetite for improved measurement, and NCQA wants to be part of this change. The State Health IT Conference convened public and private sector thought leaders across the country to share ideas and strategies for implementing state health IT systems—now and in the future—and NCQA hosted a panel on “The Future of Digital Quality Measurement.” Our session highlighted ways states can enhance their data infrastructure to enable standardization of data across systems:
· Panel moderator was NCQA’s Wendy Talbot, AVP, Measure Collection & Audit.
· David Kendrick, MD, CEO of MyHealth Access Network, laid the foundation for the data divide discussion.
· David Kelley, MD, Chief Medical Officer for the Pennsylvania Department of Human Services Office of Medical Assistance Programs and Office of Long-Term Living, discussed how states can make digital strides.
· Dan Porreca, Executive Director of HEALTHeLINK, gave an overview of HEALTHeLINK’s role in NCQA’s Data Aggregator Validation (DAV) program.
First, the Problem
Health care data is fragmented. In an ideal world of interoperability, it’s housed in one place and works toward a shared goal of improving health care. But, as Dr. Kendrick assured us, the ideal world hasn’t happened, even in the most sophisticated systems. For example: MyHealth, which Dr. Kendrick oversees, is considered a communitywide health information system, but the medical records of 70% of its attributed patients are in two or more systems. Patients not only may not always have access to their medical information, they might not even know where to look for it.
Then, the Solution
Dr. Kendrick proposed that a “mid-tier data source”—something like a health information exchange—could help streamline data into one place and ensure its quality, if the data has been verified and validated. States are on varying levels of readiness for digital reporting, as expressed by the panelists, but there are steps they can take to prepare.
Pennsylvania Medicaid gave insight into how states can leverage policy decisions to move toward standardized digital quality reporting. One way is to leverage Medicaid contracts. Pennsylvania requires its MCOs to join at least one state-certified HIO, and MCOs must ensure that Pennsylvania PCMHs are connected to an HIO as well. Pennsylvania Medicaid also requires MCOs to report eligible measures using the NCQA Electronic Clinical Data System (ECDS) method. (ECDS is a new reporting method that helps plans collect and report structured electronic clinical data for HEDIS quality measurement and quality improvement. Read more about the ECDS method here .)
To support the idea that a middle-tier data source must be verified and validated, Pennsylvania encouraged its HIOs to develop eCQM certification directly or with a certified vendor. Its takeaways to states were:
· Use MCO contracts to advance adoption of digital quality measures (ECDS, PCMH, ONAF).
· Use HIO grants to onboard providers that will enable robust electronic quality measure extraction.
· Require MCOs to contract with HIOs and develop a digital quality measurement strategy.
· Use value-based incentive programs that encourage digital quality measurement.
Ensuring Data Is Valid
When state readiness is more firmly established, working with mid-tier data sources—like HIEs or HIOs—to require validation will help vendors, health plans and practices in the long run.
Panelist Dan Porreca shared HEALTHeLINK’s experience participating in the pilot DAV program, which validates mid-tier data sources. As an HIE in New York state, HEALTHeLINK was required to demonstrate that it could reach a high enough standard for data to be leveraged by organizations. Its primary goal was to reduce administrative costs to health plans and practices for HEDIS data. Dan thinks the program had an overall positive impact on HEALTHeLINK’s data quality program:
· It provided important insights into data quality gaps.
· Feedback helped HEDIS reporting support for payers and for quality
measures in the Population Health tool.
· The Data Quality Tool streamlined the validation process.
· Health plans are excited about working with HEALTHeLINK.
Data validation can be the first step on the way to data that has value data. NCQA looks forward to engaging with states on their data journey!
To learn more about our vision and the steps we must take as an industry, read NCQA’s Enabling a Digital Quality System .
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Amy Maciejowski|Program Manager, State Affairs|NCQA
Amy Maciejowski is a manager on the State Affairs Team at NCQA. She assists state leaders as they navigate NCQA programs and products that enhance a state’s quality initiatives. She was previously a Communications Specialist at NCQA, supporting internal and external communications across the company with the goal to increase NCQA’s consumer facing brand. She was the main content curator for public policy blog posts, social media strategies and infographics to bring awareness to the health care quality agenda. Amy holds a master’s degree in Political Communications from American University and a
Bachelor’s Degree in Print Journalism and Public Policy from Quinnipiac University.