Laying the Groundwork for Success in Digital Quality Management


If you are not talking about digital quality measures (dQMs), Fast Healthcare Interoperability Resources Application Program Interfaces (FHIR APIs) or Electronic Clinical Data Systems (ECDS), then it's time to get engaged. The future of healthcare quality and performance reporting is here and it’s going to change how you work.

In a National Committee for Quality Assurance’s (NCQA) Digital Quality Summit webinar from June 14, 2022, CMS reiterated that the industry is in a time of healthcare transformation and it's essential for health plan leaders to make the transition to digital quality management.

Throughout the webinar, CMS outlined the strategy and implementation behind dQMs and the importance of getting operational experience with the tools that will lay the groundwork for success moving forward.

“If I would say one thing, it is to become very literate around FHIR APIs. Begin implementing them in your organizations and ensure that you are capable of doing this because we think this is going to be essential for the future,” said Michelle Schrieber, Deputy Director of the Center for Clinical Standards and Director of the Quality Measurement and Value-Based Incentives Group.

So, what should you do to help your health plan make the jump to digital quality management?

1. Ramp Up Your Organization’s Knowledge

Get connected with online discussions like the NCQA’s Digital Measurement Community, ask questions, attend conferences and webinars on digital quality management, get familiar with CMS’ dQM Strategic Roadmap and reach out to experts to help you and your plan leaders get engaged in transformation to digital quality.

Healthmine is performing digital and ECDS readiness assessments and onsite or virtual leadership training sessions covering transformation topics including digital measures, ECDS measure requirements and health equity program needs.

2. Get IT Involved in the Conversation

IT will play a major role in modernizing and expanding data exchange and data management. The data needed for digital measures can no longer be captured by an individual department solely for the purpose of a select set of Healthcare Effectiveness Data and Information Set (HEDIS®) measures. What is considered supplemental data and used only for HEDIS will need to be expanded to a much wider set of data elements and capture data for all members in the health plan and not just from a smaller subset of participating provider groups.

To succeed in the new normal, IT will need to align interoperability programs, data warehouse structure updates, risk adjustment data, HEDIS supplemental data, admission discharge-transfer (ADT) feeds, and payor reporting into a vision to support interoperable data sharing and measurement reporting.

Bringing your IT team to the table as early as possible will enable you to determine the necessary resources needed to accelerate digital transformation and what will be required of them on a data operability and infrastructure level. Teams are encouraged to learn about the technical requirements for dQM featured on the Electronic Clinical Quality Improvement (eCQI) Resource Center.

3. Convert Your Claims System to ECDS

Initiate a conversion to ECDS strategy focused on capturing the data elements once only available via medical record reviews. You will need to review previously optional ECDS measures that are likely to become required soon and will force you to capture data not currently available from your claims system.

4. Develop a Road Map for FHIR Conversion and dQM Production

The benefits of having a standard data format and language in which to produce data and reporting will be a significant differentiator for health plan performance. A detailed road map will be necessary to develop an organization-wide set of strategic initiatives needed for digital transformation. This should include a prioritization of goals that is aligned with existing programs and budgets and your organization’s digital transformation.

5. Begin Capturing Health Equity Data

Prioritize data capture for your health equity programs to improve the identification of social risk factors and social determinants of health and link to current quality metrics.

6. Don’t Forget About Your Provider Network

Start preparing your provider network for new measures and new levels of data exchange. The ECDS measures will eventually relieve the burden of medical record reviews, but it means providers will need to code services previously left out of claims and increase participation in data sharing either directly with health plans or with curators and state exchanges. Look at contracting and potential changes to your provider incentives to help drive early digital adoption.

It’s the middle of summer and before Star Ratings are released and redirect our attention to any fourth quarter performance improvement push, it is a great time to assess what you need to do to align with the shift happening in healthcare.

Every member of the Healthmine Consulting and Professional Services team has weathered seasons of significant changes and established strategies for 4+ star success even during the most tumultuous periods of industry change. Contact Dwight Pattison for more information about the transition to digital measures.

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