Helping States Move Towards a Digital Quality System

As health care systems evolve to support greater interoperability of electronic health care information, quality measurement must also evolve. Its future will be enabled by data standardization and exchange. Digital transformation is key to NCQA’s strategy to make measurement of quality and equity in health care more precise, actionable, timely and easier to implement. Digital quality measures (dQM) will support consistent calculations and generate real-time results that can drive improved care. This resource guide outlines considerations and opportunities for state regulators supporting the move toward the digital quality system of tomorrow.

Supporting Advancements in Interoperability

Federal regulations from Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS) outline requirements to support better interoperability of electronic health care information using Fast Healthcare Interoperability Resources (FHIR®)1 application programming interfaces.2 By adopting this standard for exchanging information, health care platforms can easily communicate with each other and share data efficiently.

While much of the effort to adopt FHIR will impact health IT vendors, providers and payers, states can also play a role in supporting interoperability, by investing in health information organizations and exchanges (HIO/HIE) and/or connecting to larger regional exchanges. They can also develop policies that encourage or require providers and payers to exchange data with these entities.

Where States Can Start

Explore resources that can help support the journey to data interoperability:

• National Governors Association white paper: State Strategies to Advance Health Data Interoperability.  

• CMS guidance for states on new interoperability rules.  

• The Da Vinci Project is a private sector initiative to help payers and providers impact clinical, quality, cost and care management outcomes. Da Vinci uses a multi-stakeholder process to promote adoption of standardized solutions, and publishes implementation guides that support data exchange between payers and providers for specific use cases.   

• The Gravity Project seeks to identify coded data elements and associated value sets to represent SDOH data documented in EHRs across four clinical activities: screening, diagnosis, planning and interventions. The project focuses on three social risk domains: food insecurity; housing instability and quality; and transportation access. 

Standardizing Quality Measurement

Digital Quality Measures

dQMs are self-contained collections of executable files (software) published in a standardized format (FHIR-CQL) that allows end users to interact with measures in a consistent, reliable and interoperable manner. DQMs reduce the burden of measurement, improve delivery of specifications and make it easier to use measure content. HEDIS dQMs are available through NCQA’s Digital Content Services.

Leveraging Clinical Data

Although HEDIS measures cover many populations, conditions and services, most rely on claims data and retrospective reporting methods (e.g., manual medical record review) to assess quality. In 2015, NCQA introduced Electronic Clinical Data Systems (ECDS) reporting, which encourages use and sharing of electronic clinical data from a range of sources: clinical EHRs, registries and other data sources across health care systems. ECDS reporting is part of NCQA’s larger strategy to enable a digital quality system, and aligns with the industry’s move to digital measures. Leveraging standardized electronic clinical data will be key for future quality measures, and will:

• Lead to greater insight into quality measurement and improvement.  

• Foster more patient-specific care.  

• Align quality measurement with the new world of data interoperability and value-based payment models.  

• Decrease measurement burden across the health care system. 

HEDIS Measures Developed for ECDS Reporting

NCQA introduced ECDS reporting in three depression screening and follow-up measures that assess improvement in health outcomes, but require specific information not found in claims (e.g., use of a standardized tool to assess, score and monitor depression). Additional measures addressing alcohol screening, prenatal and postpartum care, immunizations and social needs were gradually introduced.

NCQA is evolving a subset of measures that use “traditional” HEDIS reporting methods (administrative and hybrid) to ECDS-only reporting. We are exploring expansion of the ECDS reporting standard across HEDIS to reduce the burden of medical record review and facilitate the transition to a fully digital quality measurement system.  

ECDS Transition Timeline for HEDIS Reporting

Proven Value in the ECDS Method

NCQA released a report summarizing MY 2021 HEDIS results for measures available for ECDS reporting. Reporting highlights include: 

• A large increase in ECDS reporting from previous years.  

• ECDS reporters represent 94% of commercial plans, 75% of Medicaid plans and 50% of Medicare plans.  

• More plans are leveraging EHR, HIE/registry and case management data for reporting.  

• ECDS reporting plans for the Medicaid product cover most states.

Enabling Standardized Clinical Data Across the Health Care System

The NCQA Data Aggregator Validation program evaluates clinical data streams to help ensure that health plans, providers, government organizations and others can trust the accuracy of aggregated clinical data for use in HEDIS reporting and other quality programs. Once validated, HIEs and other aggregators can share validated data sources as standard supplemental data for quality reporting without the need for audit. This program enables more data, and more data sources, to be trusted, useful and comparable, resulting in decreased burden, streamlined processes between health care segments and improved care quality.  

Performance results for measures available for ECDS reporting are publicly reported. Public reporting and inclusion in state programs will enable plans to compare measure results, driving improvement and leading to more investment in efforts that support electronic clinical data exchange. Visit ncqa.org/ecds for announcements about public reporting status.

State Examples Supporting Digital Quality

States can use policy levers to advance toward standardized digital quality reporting. Although the ECDS standard is new, and optional for most plans, some states require or encourage ECDS reporting to increase adoption of digital quality measures. States can also leverage contracts with MCOs to ensure that providers are connected to HIOs/HIEs, leading to more robust electronic quality measure extraction.

Engage with NCQA

• State Data Quality Network (SDQN): Our State Affairs Team hosts discussions about the challenges and opportunities state health policy leaders face in the move to digital measurement. Participants can engage and exchange best practices, identify trends that drive better quality data and discuss issues ranging from federal data exchange requirements to using FHIR and funding for data exchange. Contact us if you’re interested in joining the network.   

• Connect with the State Affairs Team: Discuss resources and options specific to your state with a member of our team. Contact us to schedule a meeting. 

• Policy Clarification Support (PCS) system: You can submit questions about NCQA programs, products or measures through My NCQA.