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 If case management data are used only by behavioral health-care providers (not by primary care providers), may these data be an ECDS data source?

Case management data may be used for measures using the ECDS reporting method if the information collected by case managers is available on request to all providers treating the same member in another setting.
Data are not required to be accessed to qualify for ECDS reporting, but must be available on request to providers providing care to the member.

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 May we use depression screening performed by case managers who are employees of a health plan and are not part of an external provider group directly serving the member?

Yes. Data collected by care/case managers employed by a health plan are appropriate, and are reported in the Case Management category in the measure report.

Care/case managers are considered part of the member’s care team because they help members manage a condition and/or their use of health care services.

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 Must the eMeasure section in the Roadmap be completed for ECDS measures?

Plans work with their NCQA-Certified auditor to complete the most appropriate section of the Roadmap for the data source. The eMeasure section is intended for use by data aggregators and EHR vendors, but may be adapted and modified. Plans should work with auditors or contact NCQA with specific questions about the eMeasure Roadmap or Audit Roadmap Section 5.

HEDIS 2018

10.15.2017 ECDS What auditing process and documentation are required for ECDS sources?

The audit process for HEDIS ECDS measures is evolving. Data sources fall under audit requirements for standard supplemental data. Plans complete a Roadmap for each data source so the NCQA-Certified auditor is aware of all data that are being considered for reporting. Auditors validate policies and procedures for each data source (e.g., file layout, mapping). Although primary source verification is not required, auditors may want to validate the primary source during an initial review of data, to ensure accuracy and validity.

HEDIS 2018

10.15.2017 ECDS If the same data source is used as ECDS and as supplemental data, are health plans required to submit separate Roadmaps/documentation?

Plans should work with their NCQA-Certified auditor to accurately identify all data sources being considered for HEDIS reporting, whether the source is used for ECDS measures or for other HEDIS domain measures. If a plan completed an Audit Roadmap (Section 5) and will use the data source for both supplemental data and ECDS, this should be noted.

HEDIS 2018

10.15.2017 ECDS Are there standard guidelines for how an auditor determines and approves an ECDS database and the amount of provider accessibility needed?

There are no specific ECDS guidelines for auditor approval of ECDS data sources. Data sources must meet the ECDS requirements and must be reputable—containing accurate, complete and reliable clinical data. Auditors use the same validation methods as for all other data sources. For example, for claims data, auditors validate the accuracy and completeness of the plan’s claims data. For a case management system, auditors review the system, the processes for capturing data and whether data can be extracted from the system. NCQA will add guidance to audit requirements as we learn more about data sources being used.

HEDIS 2018

10.15.2017 ECDS What is ECDS?

Electronic Clinical Data Systems (ECDS) are a network of databases containing plan members’ personal health information and records of their experiences with the health care system. ECDS may also support other care-related activities, directly or indirectly, through various interfaces that include evidence-based decision support, quality management and outcome reporting.

HEDIS 2018

10.15.2017 ECDS May electronic data feeds from groups that include screenings be used if depression screening results are included?

Electronic data feeds are appropriate for ECDS reporting if they include the standard data required by the measure specifications (e.g., PHQ-9 total score, LOINC code for alcohol screening performed).
All data sources used for ECDS reporting must be reviewed and approved by NCQA-Certified auditors to ensure they meet domain requirements.

HEDIS 2018