What To Do When NCQA Requires HEDIS® Measure Recertification

In Affinite Quality, HEDIS & Quality Management by Zola Trascher

For health plan executives, Medical Directors, quality managers and clinical leaders of health plans, achieving high Healthcare Effectiveness Data and Information Set (HEDIS®) scores from the National Committee for Quality Assurance (NCQA), is critical to plan performance and improving member outcomes.  Vital Data Technology’s Affinitē Quality Cloud-based module is built on the Affinitē platform’s advanced analytics and artificial intelligence to identify, stratify and prioritize cases to close care gaps faster, and to improve medical record review.  For repetitive tasks, machine learning techniques are applied to ensure the prioritization process is improved over time, without requiring additional staff time.

What Happens When NCQA Requires HEDIS Quality-Management Software Solutions To Recertify?

NCQA’s Measure Certification program validates the integrity of the software code that produces results for each measure. But this year, several fully HEDIS® certified products were required to recertify in as many as 9 key measures, such as Controlling High Blood Pressure (CBP) and Use of Opioids at High Dosage (UOD).  When these discoveries are made, health plans also have to make unforeseen adjustments to their processes and programs.  This can be VERY time-consuming for health plans who host quality-management software on-premise since they have to re-update the software every time NCQA requires the plan to re-certify a measure(s).

Want A Reliable Alternative? Get To Know Affinitē Quality

Having to deal with measures requiring recertification in your HEDIS® tool mid-year can be troublesome. More and more health plans have moved to Affinitē Quality’s approach, by leveraging a cloud-based solution that is kept up-to-date with the direction of clinical and quality practitioners and HEDIS® experts. This approach ensures the technology development is led by real-world application, rather than the other way around, gives your quality team the assurance their work is in line with the NCQA’s 82 measures for the current plan year. This makes your work during “HEDIS season” less stressful because you have the assurance that all measures – including all hybrid measures – are up-to-date in your HEDIS reporting platform.

Vital Data Technology’s Affinitē Quality HEDIS quality management solution received full certification for all 82, 2018 HEDIS measures from NCQA.  It’s comforting to know the solution did not require any recertifications for any measures for HEDIS 2018, or during any of the prior 5 years in which Vital Data Technology has received certification from the body.

> Request Your Affinitē Quality Demonstration

What is NCQA’s Role and Relationship with Health Plans?

NCQA’s role and relationship with health plans and their members is defined as follows: “The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.

The NCQA seal is a widely recognized symbol of quality. Organizations incorporating the seal into advertising and marketing materials must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high-quality care and service.

NCQA has helped to build consensus around important health care quality issues by working with large employers, policymakers, doctors, patients and health plans to decide what’s important, how to measure it, and how to promote improvement. That consensus is invaluable — transforming our health care system requires the collected will and resources of all these constituencies and more.

NCQA’s programs and services reflect a straightforward formula for improvement: Measure,. Analyze,. Improve,. Repeat. NCQA makes this process possible in healthcare by developing quality standards and performance measures for a broad range of healthcare entities. These measures and standards are the tools that organizations and individuals can use to identify opportunities for improvement. The annual reporting of performance against such measures has become a focal point for the media, consumers, and health plans, which use these results to set their improvement agendas for the following year.

NCQA’s contribution to the health care system is regularly measured in the form of statistics, that track the quality of care delivered, by the nation’s leading health plans. Every year for the past five years, these numbers have improved; healthcare protocols have been refined, doctors have learned new ways to practice, and patients have become more engaged in their care. Those improvements in quality care translate into lives saved, illnesses avoided and costs reduced. For instance, for every additional person who receives beta blockers after a heart attack, has a 40% reduction in their change of suffering a second, perhaps fatal, heart attack.

NCQA consistently raises the bar. Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA’s seal of approval. Even more stringent standards are being developed year after year. These standards will promote the adoption of strategies that we believe will improve care, enhance service, and reduce costs. These strategies include pay for performance programs with transparent physician-level measurement, and more effective care management and disease management programs, , giving all consumers of health care data the information they need in a timely manner.

Source: http://www.ncqa.org/about-ncqa, August 29, 2018.

Share on