Quality Reporting and Payment

This workstream encompasses a range of benchmarking and incentive programs. NCQA’s HEDIS measures are used for health plan ratings and payment programs like CMS Star ratings, state Medicaid reporting and many alternative payment models and value-based care programs. The transition to digital quality will support accurate and timely reporting from more data sources to assess quality, manage patient populations and help maximize incentive payments in value-based care.

Resources will be continuously added and updated, so check back often or sign up to receive updates.

What Is the Digital Quality Transition Playbook?

In this section, you will find the Digital Playbook and resources that are specific to the quality reporting and payment workstream. Topics range from identifying test programs for reporting use cases to phasing out traditional measures.

Digital Introduction – Phase 1	Digital Enabled – Phase 2	Fully Digital – Phase 3	Digital Only – Phase 4
Identify “test” programs (e.g., value-based care) where a subset of available measures can be piloted. Utilize the DCS reference engine to process measures. Establish a plan to put initial program(s) into production. Plan for reporting use case; consider hybrid and survey measures; coordinate with data ops and software vendors. Assess current quality reporting programs and software, and their digital quality capabilities and roadmaps.	Prepare for and implement value-based care use case in production or for parallel run. Prepare for reporting; use case pilot or parallel run. Establish rate comparison program and mitigation plans for parallel runs. Start implementing or updating vendor software to support digital quality use cases.	Plan for hybrid phase-out approach once dates have been announced. Continue parallel runs and rate comparison. Create plan to utilize ECDS data collection.	Finish transitioning remaining traditional measure development and certification. Phase out processing of traditional measures.