Yes. With the retirement of the FPC measure, organizations may reduce the sample size for the PPC measure using the lowest rate of the 2 indicators from the current year’s administrative rate or the prior year’s audited, product line-specific rate.
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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11.15.2017 Guidelines for Calculations and Sampling The footnote on page 45 of HEDIS 2018 Volume 2 indicates that the lowest Prior Year rate from “Prenatal and Postpartum Care” and “Frequency of Prenatal Care” should be used to reduce the sample size for PPC. Given that FPC was retired with the HEDIS 2018 Volume 2 Technical Update, should the PPC MRSS use the lower rate of the Postpartum and Prenatal care indicators?
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 |
This applies to the following Programs and Years:
PCMH 201710.15.2017 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.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 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.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS What HEDIS Effectiveness of Care measures will move to ECDS?
NCQA is evaluating existing HEDIS measures, eCQMs and other de novo measure concepts for inclusion in the ECDS domain. Selected measures will be reengineered and retested, as necessary, and must be approved by the CPM before their release in ECDS, consistent with other HEDIS measures.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS What is the IP-ECDS Coverage Rate threshold for public reporting of ECDS measure results?
Organizations do not report an IP-ECDS coverage rate; they report a count of members in the initial population covered by ECDS. NCQA does not publicly report these data, which are for internal NCQA use and for benchmarking analysis to help determine the timeline for public reporting.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 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).
This applies to the following Programs and Years:
HEDIS 201810.15.2017 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.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS Are all data used to determine member compliance with the denominator, numerator or exclusion required to come from an ECDS, or may data from multiple sources be used?
ECDS reporting encourages use of multiple data sources to provide a complete and accurate picture of the health care experience. Transactional and clinical data from several sources may be used for ECDS reporting if data meet eligibility criteria. Click here for information on allowable data sources: http://www.ncqa.org/HEDISQualityMeasurement/ECDS/AllowableData.aspx
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS What file formats are acceptable for transmitting data between the plan and the care team at the point of service?
NCQA does not specify file formats for exchanging clinical information, but strongly encourages adherence to Health Level Seven International (HL7) standards for clinical document exchange (e.g., QRDA, CCD) and electronic health care information exchange (e.g., FHIR).
This applies to the following Programs and Years:
HEDIS 201810.15.2017 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.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 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:
