The US healthcare system is on the cusp of a revolution in quality measurement, reporting and benchmarking, driven by the transformation of HEDIS (Healthcare Effectiveness Data and Information Set) reporting. After years of anticipation, the "digital future" of quality measurement has finally arrived. The National Committee for Quality Assurance (NCQA) has set an ambitious goal to fully digitalize HEDIS measurement by 2030[1], with all measures specified for digital data and delivered through its Digital Content Services. This aligns with the Centers for Medicare and Medicaid Services' (CMS) strategic roadmap for digital quality measurement[2], which aims to leverage standardized, interoperable data for all reporting programs by 2030. The impact will be far-reaching, affecting not only Medicare Advantage Star Ratings but also Marketplace Quality Rating System (QRS) reporting and Medicaid reporting requirements.
This six-part blog series will serve as your comprehensive guide to navigating the digital transformation of quality measurement. We'll explore the significant changes underway, including the updated formatting of HEDIS measures to align with the FHIR (Fast Healthcare Interoperability Resources) standard, as well as the introduction of new terminology and the expanded use of Electronic Clinical Data Systems (ECDS) reporting. With the eventual retirement of the hybrid methodology for all applicable HEDIS measures by Measurement Year 2029, it's essential to understand the implications of these changes and how to prepare for the digital future of quality measurement. Join us as we delve into the details of this transformation and provide insights on how to thrive in the new landscape of quality measurement.
The Evolution of HEDIS: A New Era in Healthcare Measurement
For decades, HEDIS has been the gold standard for measuring healthcare performance, particularly in the context of NCQA accreditation and Value-Based Contracts. However, the traditional approach to HEDIS measurement has its limitations, including time lags between care delivery and measure reporting, resource-intensive processes and incomplete data.
In response to these challenges, the NCQA has launched a multi-year initiative to modernize the HEDIS program. The goals are threefold: to develop pathways for retrieving and leveraging electronic clinical quality data, to enhance and support accountability, improvement, reporting and value-based payment, and to reduce the burden and cost of measurement over the long term.
This digital transition is a fundamental shift for the healthcare industry, and it's essential to understand what it means for quality measurement. Between now and 2030, quality measurement will undergo significant changes, transforming the way healthcare organizations measure and report quality. This transition began with the introduction of the ECDS domain in 2016, which aimed to encourage sharing and interoperability of health data systems. ECDS measures are designed to leverage the expansive information available in electronic clinical datasets for quality improvement, using structured data from EHRs, HIEs, clinical registries and care management solutions.
NCQA has laid out a four-phase plan to achieve this digital transition[3]. The ultimate goal is to eliminate traditional paper specifications and replace them with delivery through their Digital Content Services. We are currently in Phase 2, where NCQA is releasing measures through their Digital Content Services while still providing traditional specifications. Vendors are undergoing measure development and testing, and healthcare organizations are preparing for the transition to digital measures.
As we navigate this digital transition, it's essential to understand the role of Digital Content Services in delivering digital measure specifications. Digital Content Services provides a centralized repository that allows healthcare organizations to access and implement measures in a standardized and efficient way. This platform supports the use of Clinical Quality Language (CQL) and Fast Healthcare Interoperability Resources (FHIR) standards, enabling the creation of machine-readable measures that can be easily integrated into electronic health records (EHRs) and other healthcare systems.
By providing a standardized and automated way to distribute and implement digital measures, Digital Content Services reduces the administrative burden associated with measure implementation and enables healthcare organizations to focus on improving the quality of care they provide. As we move forward in this digital transition, it's crucial to stay informed and adapt to the changing landscape of quality measurement.
The Significance of Digital Quality Measures
The term "digital quality measures" represents a profound shift in the way healthcare quality is measured and reported. At its core, this is a transformation that brings two major innovations to the forefront, revolutionizing the way we approach healthcare quality measurement.
Together, these changes in measurement and reporting can help healthcare organizations identify areas for improvement, optimize care pathways, and ultimately deliver better outcomes for patients. See how we helped one health plan with Commercial, Marketplace and Medicare members, and with seven different submissions to NCQA, streamline their complex HEDIS solution.
What's at Stake for Health Plans and Providers
The shift to digital quality measures has significant implications for health plans and providers. Organizations that fail to adapt to this new landscape risk falling behind in several key areas.
However, organizations that embrace digital measurement can reap significant benefits. They can gain a richer view of patient care, with more comprehensive and timely data that informs their quality improvement efforts. They can also enjoy more timely insights, enabling them to identify areas for improvement and make data-driven decisions. Perhaps most importantly, digital measurement can help organizations better align with provider workflows, reducing administrative burden and supporting more seamless care coordination. By embracing digital quality measures, health plans and providers can position themselves for success in a rapidly changing healthcare landscape.
Where to Begin
Embarking on a digital transformation journey is a complex undertaking that requires more than just a technology upgrade. It demands a fundamental shift in data governance, infrastructure and partnerships. To get started, it's essential to take a step back and assess your organization's current state of readiness.
Begin by asking yourself some critical questions.
Even if your organization is just starting out on this journey, you can still make meaningful progress by taking a few key steps. Identify the gaps in your data and prioritize the measures that will have the most significant impact on your organization. Then explore potential partnerships with data aggregators or HIEs that can help fill those gaps and support your digital transformation efforts. By taking these initial steps, you can position your organization for success in the complex landscape of digital quality.
What's Next in Our Series
As we continue to navigate the landscape of digital quality measures, our next post will explore the critical distinction between digital quality measures and ECDS. We'll explore what it means to operationalize these concepts within your organization and provide practical insights to help you overcome the challenges that come with implementation. Stay tuned for expert advice and real-world examples that will help you prepare not just for the future of healthcare, but for the present moment.
Contact us to learn more about how 天美传媒 can help you on your digital journey.
[1]
[2]
[5]