Building a more equitable, sustainable and responsible healthcare system.
Our recommendations represent a vision for evolving the current quality measurement ecosystem while maintaining its most effective elements. A few key themes recur.
- The importance of refining and developing quality measurement to help stakeholders drive toward health equity and address social determinants of health.
- The potential to reduce burden and improve care by moving to a digital quality measurement system that captures quality data during care delivery and provides results and decision support much more rapidly.
- The essential role of data validation to ensure accurate payments in value-based models.
The National Committee for Quality Assurance (NCQA) congratulates President-Elect Biden and Vice President-Elect Harris on their victory. NCQA is a non-profit, independent organization that since 1990 has worked to improve healthcare through measurement, transparency, and accountability.
We accredit health plans that represent nearly 180 million covered lives — including 9 million in ACA Marketplaces, 14 million in Medicare Advantage and another 44 million in Medicaid managed care. We also operate the largest Patient-Centered Medical Home (PCMH) program in the country, with 1 in 5 primary care clinicians practicing in an NCQA-recognized PCMH.
For 25 years we have stewarded the Healthcare Effectiveness Data and Information Set (HEDIS®), which is the basis for nearly all value-based and performance measurement systems in the nation.
The COVID-19 pandemic has highlighted the need for tools to better identify and address health disparities and under-performance throughout the healthcare system. The pandemic also bolstered the case to accelerate the move to value-based payment models. Entities in value-based models that focus on population health and accountability had systems of care in place. They were able to quickly adapt to the changing environment to provide services for their patients and escaped the severe financial disruptions experienced by the loss of fee-for-service revenue.
Yet, value-based payments require an assessment of quality and key stakeholders continue to raise concerns about the burden involved with measurement. Digitizing and automating the processes related to quality reporting, management, and improvement can result in better measures, better measurement systems, and better data – while also dramatically reducing this burden. Digital measures use data generated by clinicians and their teams in the course of caring for their patients and therefore greatly reduce manual processes and inefficient workflows, freeing clinicians to focus on patient care.
As we transition to a digital quality future amid tremendous disruption in society and the medical world, the clear view that quality measurement provides of where we stand and where we need to go is more important than ever. It is essential that we continue to monitor and reward quality while simultaneously building a platform for the future. The good news is that addressing equity, value and burden are not mutually exclusive. In fact, they are mutually dependent on the move to digital measurement.
Enabling a Scalable Digital Quality Infrastructure
Vision: A scalable, sustainable digital quality infrastructure “utility” that enables reduced waste and burden in quality reporting; allows measurement across levels of the healthcare system; more accurately identifies high-value care; and enables a “learning health system” that leverages existing guidelines and clinical inputs to improve care in real time.
The Urgent Need to Advance Health Equity
Vision: A healthcare system that is enabled, fully resourced, and actively and effectively engaged in promoting health equity and holding stakeholders accountable for doing so.
Moving to Digital Patient Experience Measurement
Vision: A more robust, rapid, and targeted patient experience measurement system that empowers individuals and enhances the effectiveness of value-based payment (VBP) arrangements in driving higher quality and better outcomes.
Strengthening Medicare Value-Based Programs
Vision: A strong and growing portfolio of value-based purchasing programs that drive patient-centered coordination, alignment, and accountability across levels of care, with reduced burden and the data necessary to identify, improve, reward and fund equitable, high-quality care for Medicare beneficiaries.