NCQA Calls for Digital Quality Measures in Value-Based Care Plans

The National Committee for Quality Assurance (NCQA) released a report with health equity recommendations for HHS and CMS, including enabling a digital quality measure system and strengthening Medicare value-based care plans.

The report notes that currently, healthcare data and quality measures are fragmented across health plans, impeding the delivery of coordinated, value-based care. In order to promote consistent quality reporting, NCQA recommends that a digital quality system be put in place, thereby reducing the time and cost to distribute and implement value-based care measures.

“The digital quality utility we envision aligns closely with the ‘secure, data-driven ecosystem to accelerate research and innovation’ contemplated in the 2020–2025 Federal Health IT Strategic Plan and would support the Centers for Medicare & Medicaid Services (CMS) goal of requiring all quality measures to be reported digitally by 2030,” the report authors wrote.

For example, Electronic Clinical Data System measures (ECDS)—which use data generated from care delivery, electronic health records (EHRs), health information exchanges (HIEs), registries, and other digital sources—allow for measuring individual member outcomes rather than the general population.

A universal digital quality measure system would allow payers to hold providers accountable for addressing issues of care quality and health inequity, including racial health disparities that have been underscored by COVID-19.

NCQA acknowledged that most Medicaid and commercial plans do not regularly collect or report membership data regarding race or ethnicity data, thereby preventing effective evaluation and action to address health inequity. However, over 80 percent of Medicare Advantage (MA) plans have complete or partially complete race and ethnicity data.

There is great interest in making care disparities the focus of improvement efforts and value-based payments. Recently, the HHS Assistant Secretary for Planning and Evaluation (ASPE) called for CMS to incorporate health equity data in its quality measurement and incentive programs across the country.

Some states are already using health equity data to drive value-based care. For instance, a portion of Michigan’s plan incentives are based on their ability to close gaps in racial health disparities.

“Plans can serve as critical partners to effectively tackle the root causes of poor health and address disparities to improve the health of individuals and their communities,” the report authors wrote. “This is reflected in the continued investment and increase in supplemental benefits offered by MA plans to address social determinants of health.”

The Medicare Advantage (MA) Star Ratings program, noted as the most successful value-based program in healthcare by NCQA, is a prime example of how financial incentives aligned with clear quality measurement can improve patient outcomes.

“MA has seen a surge in enrollment, while also improving quality, containing costs and premiums, and enabling individuals to choose from an array of high-quality plans,” the report authors wrote.

“It includes a broad range of meaningful measures, with all plans reporting the same measures, ensuring meaningful benchmarking and comparison. Measures have clear specifications and rigorous auditing for all measures and all plans occurs before reporting to give stakeholders confidence that the results are accurate and valid.”

Since MA has been extremely successful in providing value-based, member-centered care, NCQA called for CMS to extend the improvements already made through MA to all value-based plans.

“Medicare has blazed a trail for value-based programs in healthcare and should work to consolidate the gains already realized and learn from the successes and setbacks,” the report authors wrote.

“CMS should align its value-based plans around a few fundamental pillars: integrity (of data and performance assessment); coordination (of structure and expectations across programs with the goal of moving toward systems of care); and collaboration (with all relevant stakeholders in designing and implementing value-based plans).”