FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.

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11.09.2017 Additional Resources Are there any outside resources that may help me in the PCMH transformation process?

Content Area	Criteria	Resource Link	Description
TC	02	http://www.ihi.org/resources/Pages/Changes/OptimizetheCareTeam.aspx	Resource on how to optimize staff responsibilities
	02	https://www.integration.samhsa.gov/operations-administration/OATI_Tool3_ART.pdf	Toolkit on how to optimize administrative staff responsibilities to benefit clinical practice
	02	http://www.improvingprimarycare.org/team/pcp	Resource on how to optimize staff responsibilities
	04	https://www.stepsforward.org/modules/pfac	Module teaching how to create a patient advisory council
	07	http://www.nachc.org/research-and-data/prapare/toolkit/	Toolkit to better understand social determinants of health
	08	https://integrationacademy.ahrq.gov/sites/default/files/AHRQ_AcademyGuidebook.pdf	Information on behavioral healthcare integration in primary practice
KM	02 G	https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/	Social needs screening toolkit
	12	https://www.cdc.gov/media/releases/2012/p0614_preventive_health.html	Discussion on benefits of preventative care
	14	https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/match/match.pdf	Guide to medication reconciliation at transitions
	16	http://www.teachbacktraining.org/	Information on teach back training
	17	http://www.improvingprimarycare.org/work/medication-management	Guide to medication management
	24	https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/index.html	Toolkit for shared decision making
	24	http://msdmc.org/3-assess/	Toolkit for shared decision making
	24	https://shareddecisions.mayoclinic.org/	Informative website about shared decision making
	13	http://www.jabfm.org/content/28/2/170.full.pdf	"Patient Empanelment: The Importance of Understanding Who Is at Home in a Medical Home"
AC	13	http://www.annfammed.org/content/10/5/396.full	"Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation"
		http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/aug/1764_hong_caring_for_high_need_high_cost_patients_ccm_ib.pdf	Article discussing benefits and strategies to care management
CM	03	https://nf.aafp.org/Shop/practice-transformation/risk-stratified-care-mgmt-rubric	Risk stratification rubric available to members of the AAFP
	03	http://www.calquality.org/storage/documents/cqc_complexcaremanagement_toolkit_final.pdf	Risk stratification rubric from California Quality Collaborative
	03	http://www.millimanriskadjustment.com/	MARA – The Milliman Advanced Risk Adjuster is a model of risk stratification in which risk scores are normalized to a given population.
	04	http://www.aafp.org/fpm/2015/0100/fpm20150100p7-rt1.pdf	Care Plan template from AAFP, not exclusive to members
	06	http://www.dartmouthatlas.org/downloads/reports/preference_sensitive.pdf	Resource on how to incorporate patient preference into care management
	08	http://www.ihi.org/resources/pages/tools/selfmanagementtoolkitforclinicians.aspx	Toolkit to aid clinicians in promoting self-management
	08	https://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/index.html	Resources on self management
	08	http://champsonline.org/tools-products/clinical-resources/patient-education-tools/patient-self-management-tools	Condition specific self management tools
	08	https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/	Article discussing proper communication between primary and specialist clinicians
CC	14	http://nihcr.org/analysis/improving-care-delivery/prevention-improving-health/ed-coordination/	Information on improving communication between emergency and primary physicians
	16	https://share.kaiserpermanente.org/article/kaiser-permanente-study-finds-tailored-post-hospital-visits-lower-risk-readmission-medicare-advantage-patients/	Article discussing advantages of post hospital primary care visits
QI		https://www.ahrq.gov/sites/default/files/publications/files/pcmhqi2.pdf	Resource for building quality improvement in primary care
	03	http://www.ihi.org/resources/Pages/Measures/ThirdNextAvailableAppointment.aspx	Information on how to utlize third next available appointment measurement
	08	https://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod4.html	Benefits of PDSA cycle

PCMH 2017

10.15.2017 ECDS Who determines that data “qualify” for ECDS reporting?

Refer to the ECDS general guidelines for information. Request clarification through the NCQA Policy Clarification Support (PCS) system at https://my.ncqa.org or review the proposed systems with your NCQA-Certified auditor. Send requests for individual technical support with ECDS reporting to ecds@ncqa.org.

HEDIS 2018

10.15.2017 ECDS If case management information resides solely within the plan and is not shared with the PCP, may it be used as a supplemental data source for the numerator?

Case management data that are available to the PCP on request meet the requirement for use in ECDS reporting.

Supplemental data may not be used for any part of an ECDS measure unless it meets all ECDS requirements.

HEDIS 2018

10.15.2017 ECDS How do EHR vendors submit data and to whom does the submission file go?

Only health plans may submit HEDIS ECDS measure data to NCQA. EHR vendors should work with plans that use their systems to provide data that will be used to calculate HEDIS ECDS measures.

NCQA is currently certifying EHR vendors, to increase the reliability of health IT data used for reporting health care performance. Learn more at:

http://www.ncqa.org/hedis-quality-measurement/certified-survey-vendors-auditors-software-vendors/emeasure-certification.

HEDIS 2018

10.15.2017 ECDS How are ECDS different from supplemental data?

The ECDS reporting method uses much of the same data classified as supplemental for other HEDIS measures, but ECDS measures adhere to different reporting rules from those in other HEDIS domains. Unlike supplemental data used for HEDIS, data for ECDS reporting are classified by source and are used to report all measure elements (e.g., denominator, exclusions, numerator).

HEDIS 2018

10.15.2017 ECDS Is the “care team accessibility” requirement fulfilled if a member’s health record is available online and the provider can access it with the member present or with the member’s consent?

Yes. If a member’s record is available on request to any member of the care team, the requirement is met.

HEDIS 2018

10.15.2017 ECDS How do vendors get the ECDS technical specifications for the submission file format?

HEDIS ECDS technical specifications are available in the NCQA store in PDF format: http://store.ncqa.org/index.php/catalog/product/view/id/2822/s/hedis-2018-volume-2-measures-for-electronic-clinical-data-systems/. They are also available in HEDIS 2018 Technical Specifications for Health Plans, which can be purchased at the NCQA store.

Complete digital measure packages for HEDIS ECDS measures will be available for download at a future date.

HEDIS 2018

10.15.2017 Use of Opioids at High Dosage and Use of Opioids From Multiple Providers Step 2 of the UOD and UOP eligible population states to exclude “members who had only a single opioid medication (Opioid Medications List) dispensing event.” Does a member who had multiple prescriptions (for the same or different medications) on the same date of service (with no prescriptions on other dates of service during the measurement year) meet criteria for exclusion?

Yes. The intent is to exclude members who were dispensed opioids on only one date of service during the measurement year. If the member had multiple prescriptions (for the same or different medication) on one date of service and had no opioid prescriptions on another date of service during the measurement year, the member is excluded.

HEDIS 2018

10.15.2017 ECDS Must a specific provider type be able to access ECDS sources?

No. Member data collected to report a HEDIS measure using the ECDS reporting methodology must be accessible to the care team.

HEDIS 2018

10.15.2017 ECDS Clarify “data must be accessible by the health care team at point of care.”

To qualify for HEDIS ECDS reporting, practitioners/practitioner groups that are accountable for clinical services provided to members must be able to access all ECDS data used by a health plan for quality measure reporting.Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system.

HEDIS 2018

10.15.2017 ECDS How are ECDS measures different from the eMeasures in Meaningful Use?

HEDIS ECDS and eClinical Quality Measures (eCQM) developed for Meaningful Use are specified using the same data standards. eCQMs are specifically designed to use data extracted from an EHR, and HEDIS ECDS measures use multiple data sources to complete the picture of member experience across the care continuum.

HEDIS 2018

10.15.2017 ECDS If a plan wants to use its internal case management system as a data source, must there be evidence that data were shared with the provider?

To use a case management system for ECDS reporting, the system must be verified by an NCQA-Certified auditor and demonstrate (e.g., policies and procedures) that all health care providers responsible for managing a member’s condition have access to information. It is not necessary to track whether the information was accessed, but there must be evidence that data are available on request.

HEDIS 2018