On June 1, the National Committee for Quality Assurance launched its digital quality solutions pilot with six health plans, delivery systems and health information technology firms to provide feedback on the new software product aimed at improving the nation's care quality and management.
During the six-month pilot, 1UpHealth, Aetna, ApolloMed, Change Healthcare, Centauri Health Solutions and Health Care Service Corp. will assess the product's usability, test its features and discuss the impact on Healthcare Effectiveness Data and Information Set measure reporting.
"The program is an opportunity for us to learn with a subset of our key stakeholders how to deliver the highest value product as we seek to evolve the next generation of measures and measurements," NCQA Chief Product Officer Brad Ryan, MD, told Becker's.
Dr. Ryan sat down with Becker's to discuss the pilot program and the new product, which is expected to launch next year.
Editor's note: Responses were edited lightly for clarity and brevity.
Question: What does this new pilot aim to accomplish and how are health plans helping to test that?
Dr. Brad Ryan: We and other organizations like CMS describe digital quality measures as not just digital versions of traditional measures, but as actually an opportunity to create something better. If we deliver a software, we can make it configurable, more flexible and dynamic so that our content can support more use cases and quality, not just the reporting use case.
Quality improvement efforts are things that people are already doing or trying to do, but they're harder than they have to be because they have to either reverse engineer some of the logic or extrapolate from the product when it's on paper. We can build better measures because we now have opportunities to leverage clinical data and encode more richness in what we want to measure. We know a lot about what people tell us what they're trying to accomplish, where they're having difficulty and where there's opportunity to have more value. The best way, in our opinion, to really deliver on that is to get some real hands-on experience, and that's what this pilot is all about. The pilot includes health plans and vendors, folks from the health IT segments and a delivery system because we know HEDIS touches all of those entities. Combined, they can contribute to our understanding of those use cases and our ability to build and deliver the best product possible.
We hope to come out of this pilot with something we can then go to market with and launch that will have enough feature functionality to get out and continue to learn. We'll be bringing more content and more feature functionality to this product suite for probably years to come.
Q: How will this new digital product perform better than traditional paper-based methods of quality improvement?
BR: There's a huge benefit in the cost and the speed of delivering this product. The same fundamental job that NCQA has always done — helping create definition, clarity and fully specified versions of how we're going to measure and evaluate quality — now we can make it so that you can use that definition and that content to work on quality improvement and year-round performance management, not just the reporting at the end of the year. It opens up an opportunity for us to create fundamentally better measures that support value-based contracting even more directly than HEDIS does today. We think out of the gate, those cost savings and time savings are the most tangible parts of the business case for folks that want to make the shift. Over time, the benefit to the users and the benefits of the applications — particularly in the care delivery side for the folks that are actually trying to make decisions and influence quality throughout the year — will be exponentially greater over the long term.
Q: What kind of real world outcomes are you hoping will come from this product?
BR: We've now invested substantially as a country to digitize the clinical data that's sitting out there and that's being captured on a regular basis through electronic health records, but we haven't made great use of that data. One of the biggest challenges to value-based contracting is the quality side. HEDIS measures have done a lot of good and have delivered a lot of patient benefit over time, but they are blunt instruments in the traditional form.
We have an opportunity to create measures that are linked to those incentives that are more clinically oriented and less about process. For example, screening for colorectal cancer screening. The current HEDIS measure looks to see if the patients in a population that were not excluded had a qualifying diagnostic screening test with a colonoscopy or a sigmoidoscopy or some other form of screening. That's a good thing, and those numbers have increased and undoubtedly lives have been saved because of screening. But in a future where we can write measures that don't just look for whether a claim was submitted for a colonoscopy, we can write measures that look at clinical data about the findings of the screen. What were the treatments that are appropriate for the patient given the other characteristics about the patient? Were patients treated in compliance with those best practices? Did they complete their treatment? We can start to build that into the content of the measure because we can leverage that clinical data that has that richness.
Instead of just the care gap reports a clinician would receive that says, "Here's all your patients that don't have a screening exam," now you're getting information that says, "It looks like these patients are not getting the therapies that are in accordance with the recommendation."
Sometimes that's a physician's preference and there's a documentation thing that needs to happen. But sometimes that's a real quality care gap that somebody needs to address and take action on. It's much more compelling and valuable to give delivery systems information about how to close the gap.
Q: Final thoughts?
BR: For folks who are trying to understand why this is a big change and not just a software version of what we used to do — we have over 100 HEDIS vendors. Less than 20 of those vendors report the data on behalf of the health plan to NCQA. That means over 80 vendors are doing exclusively other things with the HEDIS content besides health plan reporting. The current version of our product only explicitly supports health plan reporting. That's a huge amount of industry level effort being exerted in places that we can do a better job to support.
We really feel that this is unlocking a huge amount of potential for the industry. It's both saving that time and cost to really improve on the quality of care that's being delivered by having this embedded in core business processes.