EPISODE
19

Digital Quality Transformation Made Simple

Digital transformation impacts quality. 
 But its jargon can be overwhelming. Two of NCQA’s top technologists tell you what you need to know, in clear, non-technical terms.

About The Guests

Episode Description

In this episode of Quality Matters, host Andy Reynolds and NCQA’s Chief Technology Officer Ed Yurcisin explore the role of high-quality data exchange in quality’s digital transformation. They discuss how digital HEDIS® measurement, and interoperability standards like FHIR®, aren’t just improving quality reporting, but also paving the way for broader advancements. Ed translates the technical side of digital quality measurement, explaining the importance of Clinical Quality Language—(CQL)—and highlighting NCQA’s work to standardize complex calculations through open-source tools.

As the conversation turns to CQL “engines,” Amol Vyas, NCQA Vice President for Interoperability, joins the dialogue to explain how a public-private partnership is bringing choice and confidence to the market for these important software tools. Ed also relates personal stories that illustrate the need for data interoperability, reinforcing that better data means better, safer care. As the conversation concludes, listeners are encouraged to use NCQA resources to keep current as digital quality evolves.

HEDIS measures are incorporated into government payment programs—for example, Medicare Star Ratings.

There’s incentive to enable digital HEDIS because it is tied to your CMS Star Ratings and the money a Medicare advantage plan might receive from the government. That’s not the case for other important use cases, whether it be public health or prior authorization.
So our infrastructure is tied to financial returns incenting organizations to make higher quality data accessible for digital HEDIS.

And that means if it’s good enough for digital HEDIS, it’s been cleansed and analyzed in a way that could be used for public health, could be used for prior authorization—all of these different use cases.

Ed Yurcisin

Timestamps

(02:10) Clearing a Path for Data Quality
(05:30) HEDIS “Engines” vs. HEDIS “Calculators”
(07:17) Measures’ Content vs. Software that Runs Measures
(11:18) Digital Quality Implementers Community
(19:35) The Need for Data Quality Cuts Close to Home

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