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Benefits of Digital Quality Measures for Payer Quality Reporting
Digital quality measures not only reduce provider burden, but they also can be essential for payers during a major disruption to the healthcare system.
When a major crisis hits, gathering quality measures data can be challenging or nearly impossible with the current strategies.
In order for a health plan to be accredited by the National Committee for Quality Assurance (NCQA), payers must submit data on how they meet NCQA’s specific Healthcare Effectiveness Data and Information Set (HEDIS) quality measures.
Health plans begin gathering quality data to submit to NCQA in the first months of the year after the performance year, explained Frank Micciche, vice president of public policy and external relations at NCQA.
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If a major disruption strikes at certain times of the year, it could catch the healthcare system right in the middle of this process. Furthermore, it could prevent plans from being able to gather data altogether. For example, gathering hybrid measures requires health plans to send employees physically to the provider’s office to pull charts.
“That all of a sudden became a very dangerous prospect in the early days of the pandemic,” Micciche said in Xtelligent Healthcare Media’s Healthcare Strategies podcast.
When a major disruption prevents health plans from entering providers’ offices to collect quality data, the plan may not be able to submit complete information on the previous performance year to NCQA.
While NCQA offered flexibilities to health plans caught in this conundrum during the coronavirus pandemic, the recent disruption shed light on vulnerabilities in the healthcare system’s quality measures processes.
To Micchiche and NCQA, one way to avoid this problem in the future is to expand further into digital quality measures.
Digital quality measures are quality metrics pulled not only from EHRs, but also from information registries and health information exchanges. The goal is to eliminate provider burden and give accreditors easier access to reliable and real-time data. Additionally, payers would be able to gather data without having to physically go into the provider offices.
“The other exciting piece of digital quality is that they can be easily tailored depending on the circumstance or the patient or the population, whatever it is you're trying to adjust for or to hone in on when measuring quality,” Micciche added.
The movement towards interoperability is one step in the direction of digital quality measures, but it will take a concerted effort on the part of the healthcare industry to achieve digital quality measures. In particular, major payers in the healthcare industry will need to take more deliberate moves toward digital quality measures in order to make this a reality.
“We all have the best of intentions in terms of wanting to be able to get there,” said Micciche. “But you do need a handful of these big catalysts who can ensure that we do get there or can do everything possible to make sure that participants in the market know where we're trying to go and that they are committed to getting there.”
