NCQA Shares New Guidance for Digital HEDIS Reporting
November 1, 2024 · NCQA Communications
NCQA is leading the transition to digital HEDIS® reporting to deliver on the promise of reducing cost, burden and variability while democratizing access to quality. HEDIS is the trusted standard for health plan quality measurement, benchmarking and performance-based payment in health care. NCQA is committed to maintaining the integrity of HEDIS rates throughout the transition.
We are working closely with Digital Content Services customers to conduct ongoing testing of digitalized HEDIS measures, identifying key considerations and guidance needed for HEDIS submission, audit and benchmarking. We also launched the Digital Quality Hub to provide technical assistance and resources for organizations as they make the transition.
The move toward digital quality is accelerating, so we are sharing new guidance around the transition to digital HEDIS to help our customers understand what’s next.
Highlights of the Digital HEDIS Transition Plan
We’ve created a flexible transition plan so organizations that are prepared to adopt digital HEDIS can begin leveraging digital measures, while those needing more time can continue with traditional reporting methods until they are ready.
The following guidelines apply to the transition:
- Organizations must complete parallel reporting for a minimum of 1 measurement year before submitting digital measure results for HEDIS health plan reporting. This will help ensure valid results before using digital measures for official HEDIS reporting.
- For the health plan’s parallel reporting year, results for traditional HEDIS will be submitted through IDSS and results for digital HEDIS will be submitted in an IDSS-like environment for the same measurement year.
- Once valid results are demonstrated through parallel reporting, organizations will be able to fully transition to submitting digital measure results for HEDIS health plan reporting.
- HEDIS audits will continue to be required, but will evolve to account for changes in data and use cases.
- By about 2030, all organizations are expected to fully transition to digital HEDIS, depending on market readiness.
- During this period, NCQA will continue to provide guidance, tools and resources to help organizations transition.
Organizations are in different stages of readiness and will transition at different times; however, we strongly encourage everyone to have a plan for getting started to allow enough time to develop and test digital HEDIS measures and demonstrate valid results.
Parallel Reporting of HEDIS Measures
Although NCQA rigorously tests digital HEDIS measures to ensure they function accurately, each organization has unique data systems, and the quality and completeness of data can vary. Discrepancies might arise due to differences in how data are captured, processed or mapped into standard data models (e.g., FHIR®) compared to the traditional method.
Parallel reporting is a low-risk way for organizations to validate their readiness for digital HEDIS and help ensure that their digital HEDIS measures produce reliable results compared to traditional reporting. Ideally, organizations will perform parallel reporting on their digital HEDIS measures in the same measurement year as their traditional HEDIS measures, but some organizations may need to use the prior year’s data.
Organizations must submit traditional HEDIS health plan reporting by the regular submission deadline. The environment used for parallel reporting of digital HEDIS measures will remain open beyond the official submission period, allowing organizations more time to validate and compare digital measures output.
Certification Process for Digital HEDIS Measures
If organizations run digital measures on any CQL engine, the implementation must be certified through NCQA. This process has a lower burden than traditional measure certification.
Organizations that earn traditional measure certification will soon have the option of using FHIR test decks. This option will support the transition to digital measures by helping ensure that systems align with FHIR standards.
Technical Support and Resources
NCQA offers support, updates, implementation guides and transition resources through the Digital Quality Hub. We encourage you to connect with the vendor community for resources related to data mapping and preparation.
NCQA’s Digital Content Services customers receive a handbook and user guides focused on the technical implementation of digital measures to help them navigate the transition smoothly, as well as access to a Customer Success Manager for troubleshooting and support.
HEDIS vendors have access to the same technical implementation resources as Digital Content Services customers. If you use a vendor for HEDIS health plan reporting, ask about their digital HEDIS transition plan and timing.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
FHIR® is a registered trademark of Health Level Seven International. Its use does not constitute endorsement by HL7.
