NCQA’s Approach to the New Quality Measurement Landscape Ben Hamlin NCQA

Quality Measurement Advancing Interoperability Transforming Quality Measurement to QI Introduction HEDIS ECDS NCQA eMeasure Certification Digital Measure Collaborative Today I will be giving a brief overview of a few activities that will effect some change in the quality measurement landscape. First I will discuss the new HEDIS ECDS reporting standard intended to support wider use of electronic data for HEDIS reporting. Next I will provide an overview of how NCQA is validating eCQMs improve the precision of the data and processes used for eCQM submissions Finally I will discuss a new collaborative which represents our commitment to sharing innovative ideas and promoting wider adoption of best practices in the digital measurement space.

Use of Electronic Clinical Data Systems HEDIS ECDS

What Does Interoperability Mean? Accessibility & Usability

Electronic Clinical Data Systems (ECDS) Network of health information records within the healthcare system Improve Communication Integrate Essential Data Through direct engagement and collaboration across the care continuum Support Access So many organizations can participate, not just the fully wired With emphasis on a patient-centered, team-based approach to quality Confidential - Do Not Distribute

Electronic Clinical Data Systems (ECDS) Accelerating Innovation, Increasing Value Harmonize Specifications across programs and w/decision support Standardize Incorporate data from multiple systems - requires uniform layouts Integrate Incentivize effective sharing of electronic clinical information Confidential - Do Not Distribute

ECDS measures are reported by each data source accessed HEDIS ECDS Update for 2018 Modifications to the framework for ECDS Reporting ECDS measures are reported by each data source accessed 1) Electronic health record (EHR) -A hierarchy is used as guidance in cases where a member’s data are in multiple locations 2) Health Information Exchange / Clinical Registry 3) Case Management Registry 4) Administrative Claims http://www.ncqa.org/ECDS Confidential - Do Not Distribute

Stakeholder Outreach Use of Electronic Clinical Data Systems Outreach to stakeholders to discuss ECDS and implementation strategy and implications Discussions included: Diversion of resources from existing programs to build pipelines to share data Value proposition for payers: efficiency and innovation of method as incentive New opportunities for : data stewards registries

ECDS A future of effective data management

eMeasure Certification: Validating Logic for eCQMs

Health Plan Data Repository Certified eCQM data can be integrated into a health plan’s data repository and used as data for performance measurement reporting.

QRDA Category I and III Reports Output Files Category I Category III reports aggregated quality measure data reports raw patient- level data about a single patient

Testing includes… Ensuring that the measure-specific software code extracts the correct electronic clinical data defined in the eCQM specifications Initial Patient Population (IPP) Denominator logic Numerator logic Exclusion/Exception logic Ability to report the extracted clinical information in the standard document format called Quality Reporting Document Architecture (QRDA)

Programs Used to Generate Decks CCD Files The text files generated in the BlackCase program are then converted into a CCD file for each patient. Uses SAL to determine every decision point. Case prototypes based on the different decision points are created for each patients. Decision Points Test Patients Data is assigned to each prototype case in order to define the specific characteristics of each patient. Test patient data is generated in text files. BlackPath Program BlackCase Program BlackCCD Program

Digital Measure Collaborative

Digital Measure Collaborative Community Best Practices Supporting NCQA Measure Programs Joint effort between NCQA and its stakeholders : open forum for the exchange of ideas and innovative solutions provide access to NCQA digital measure resources that use clinically relevant information from multiple sources new research and the latest techniques for aggregating electronic clinical data for quality measure reporting

The Digital Measures Collaborative Advance reporting digital quality measures Ease labor and financial burdens  More reliable and useful measures  Create measures to digital formats  Increase the value of data Manual chart reviews are time consuming and costly Measure more Measure better Reuse data

Using common standards The Digital Measures Collaborative How do we accomplish this? Using common standards Quality Data Model (QDM) Electronic Clinical Data Systems (ECDS) Clinical Quality Language (CQL) Fast Healthcare Interoperability Resources (FHIR) and peer-problem solving