Quality Reporting and Payment

Quality reporting is used for a range of benchmarking and incentive programs. HEDIS quality measures are used for HEDIS health plan reporting and in payment programs like CMS Star ratings, state Medicaid reporting, and many alternative payment models and value-based programs. Accurate and efficient quality reporting is important for assessing quality, managing patient populations, and earning incentive payments in value-based care. This section helps health plans, care delivery organizations, and others better transition to digital quality, which will allow for more accurate and timely reporting using more data sources, which will allow organizations to better manage their quality programs.

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 will range from identifying test programs for reporting use cases to phasing out traditional measures. Be sure to sign up to be notified as updates are made, as this is the space to find frequent updates.

Digital Introduction – Phase 1Digital Enabled – Phase 2Fully Digital – Phase 3Digital 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.

Ask a Question

Have a question about digital quality? Ask a question below and a member of our team will be in touch.

Digital Hub - Contact Us

  • This field is for validation purposes and should be left unchanged.