Health information exchanges are starting to add value by helping providers and payers with quality measure reporting. In 2019 the National Committee for Quality Assurance (NCQA) began piloting a data aggregator validation (DAV) program with three HIEs in New York State, with the goal of improving ease and accuracy of HEDIS quality measure data collection and reporting.
After completing the initial pilot earlier this year, NCQA plans a “soft launch” with a few more HIEs this fall, and then a full program launch in 2021, said Wendy Talbot, M.P.H., NCQA’s assistant vice president for measure collection and audit. She was speaking Aug. 25 during a panel discussion at the virtual annual conference of the Strategic Health Information Exchange Collaborative (SHIEC). Three main goals, she said, are to “increase access to standard supplemental data, decrease chart chasing, and reduce provider burden and audit burden.”
Currently, the time and expense to verify original source data discourages plans from working with data from aggregators, Talbot explained. The DAV program would check data coming in and out of aggregators, so health plans and auditors don’t have to do this work during the HEDIS Audit.
“As health plans have been interested in using data from HIEs and other data aggregators, the burden has come at the point of the audit, where with the auditor they are required to trace this data back to the point of origin,” Talbot explained. “As you can imagine, an HIE has hundreds of connection sites, and you would be required to go back to find that data at the source. At NCQA, we thought we could set up a program where NCQA would take on the validation of the aggregators to see about validating those data at a central point in time, so the aggregator, once validated by NCQA, could share those data with an end-user.”
The goals of the program are to ensure the integrity of the data is maintained from the source —radiology, labs, provider offices and hospitals — and also to ensure that aggregators adhere to NCQA’s implementation guide, she added. “NCQA decided to create a continuity of care CCD implementation guide, which aggregators would conform to, be tested on, and then use that format to pass to the end user, so everyone would be able to predict the format this data would be received in.”
In a nutshell, here is how it works: The NCQA checks the completeness, accuracy and reliability of data that aggregators ingest from EHRs, labs, pharmacies, and other sources. It then checks that the aggregator can produce a clean Continuity of Care Document (CCD)—data in a standardized format that the aggregator can pass to health plans for HEDIS reporting.
NCQA sends the HIE aggregator synthetic data files, they work that data through their systems and return the CCD file, and NCQA examines whether it passes its test, and if there are errors, they go through several passes until they are fixed. All three HIEs in New York did pass after the test after a few rounds.
For the HIEs, this can be seen as a growth opportunity. Data hubs that have earned NCQA validation would become “standard supplemental data” sources for health plans. This status would make data aggregators attractive partners for health plans and enhance aggregators’ role in quality reporting.
One of the three HIEs participating in the pilot is HEALTHeLINK, which covers Buffalo and vicinity in Western New York. “We are excited about the potential of being a data source for aggregated data for members,” said Daniel Porreca, executive director. “Given the data we have, we are in a unique position to support that function.”
The nonprofit organization has already been playing that role as the Greater Buffalo area has participated in the Centers for Medicare and Medicaid Services’ Comprehensive Primary Care Plus (CPC+) Initiative, an advanced medical home model aimed at strengthening primary care to support improved care, better population health, and lower health costs. He said HEALTHeLINK is using the NextGen population health platform to help flag high-risk patients and identify gaps in care with the ability to drill down to the individual patient and provider level.
Porreca said the ability to combine clinical and claims data is significant. “It positions us as the most comprehensive source for quality measurement in our community. In Western New York we have a lot of patient data fragmentation. Seventy-three percent of patients have data in more than one EHR, and for diabetic patients, that figure is 94 percent.”
“We are excited about where this may take us. We are adding new measures to meet community needs,” Porreca said. For instance, the HIE works with three different independent provider associations with specific quality measure requirements. One is a safety net IPA, another involves behavioral health. “The data quality effort is never-ending,” he added.
