Health plans to go digital with HEDIS, expert says

The organization that creates the quality measures is digitizing them, leading to challenges for some large payer organizations that may find the transition difficult.

The organization that creates the quality measures is digitizing them, leading to challenges for some large payer organizations that may find the transition difficult.

The National Committee for Quality Assurance (NCQA) is making the move to digitize its Healthcare Effectiveness Data and Information Set (HEDIS) measures, but payers that are large and set in their ways could be at a competitive disadvantage, some industry experts contend.

The evolution to digitized HEDIS measures will “turbo-charge” them, contends John D’Amore, a technical advisor to NCQA and president and chief strategy officer of Farmington, Conn.-based Diameter Health, a company that cleanses medical data.

With this digitization of HEDIS measures, some health plans will remain “too baked in their ways” and will continue to collect the data as they have done for 20 years, he predicts, and that’s what could leave them at a competitive disadvantage.

Most big payers are aware of the upcoming digitization and are planning ahead, D’Amore says. “Our experience is that the clinical data acquisition strategies of larger firms tend to be more mature,” he adds. Larger plans have the scale to tackle the transition, and some have already started discussions about data acquisition with health systems, health information exchanges and electronic health record vendors.

In addition, more experienced firms are developing data use agreements that span multiple use cases, instead of negotiating agreements for just one use case. “As scalable clinical data integration accelerates, smaller and middle-sized plans will need to adopt these competencies, as well,” D’Amore says.

Once all the big payers have moved to digital HEDIS, it could make the health payers that don’t collect data this way look bad in comparison, D’Amore warns.

“Clinical data collection is already raising the bar for HEDIS reporting, and payers will need to report better scores just to stay in the same relative position,” he says. “Clinical data is also beginning to make its presence felt in risk adjustment, care coordination and advanced analytics. Having the right data at the right time in the right place can help the care team make the right decision for a patient to improve the outcome and avoid unnecessary expense.”

The continuing transition toward value-based contracts with providers will put increasing demands on quality reporting, according to D’Amore. Quality reporting itself is in the process of transitioning from a hybrid paper-digital process to something that’s electronic from end-to-end.

Reporting quality as a byproduct of providing care—that is, using electronic clinical quality measures, rather than as a separate and often manual business process—is really the only way to provide better care and drive cost out of the system, D’Amore contends.

Health plans have traditionally relied on claims data for assessing quality, but they will increasingly need to incorporate clinical data into their reporting for HEDIS, he says. Risk sharing arrangements between payers and providers will help to eliminate some of the barriers that health plans currently face in acquiring clinical data.

According to NCQA, the next generation of HEDIS digital quality measures will:

· Align quality measures across the healthcare system.
· Reduce the burden associated with measurement and reporting.
· Reduce costs of implementing and updating measures.
· Improve accuracy and validity of measure calculations and reporting.
· Provide flexibility in use of HEDIS measures.
· Enhance value for health plans.
· Build the foundation for new outcome measures.

With the release of CMS’s 2017 Meaningful Measures Initiative and NCQA’s recently released roadmap, ultimately, NCQA and CMS are hoping to sync up their goals, says Alec Bose, a spokesman for NCQA in his recent blog, entitled, "CMS Meaningful Measures-NCQA’s Digital Measures Roadmap: What’s the Connection?"

Bose says NCQA’s plan to digitize HEDIS measures will make them more meaningful, improve measurement accuracy and reduce reporting burden, which, in turn, will lower costs and reduce effort, creating what he calls, “the HEDIS of the future.”

NCQA released six digital or machine-readable measures and kicked off the HEDIS Electronic Clinical Data System (EDCS) Reporting last year. Each year over the next three years, it plans to convert between 20 and 25 additional HEDIS measures as part of its strategic plan.

This year, NCQA is providing a package of eight digital measures for traditional reporting and a package of eleven digital measures for ECDS reporting, including depression screening and follow-up for adolescents and adults; utilization of the PHQ-9 to monitor depression symptoms for adolescents and adults; depression remission or response for adolescents and adults; unhealthy alcohol use screening and follow-up; adult immunization status; and prenatal immunization status.

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