NCQA’s Eric Musser on the Future of Digital Quality Measurement
The National Committee for Quality Assurance (NCQA) recently offered several policy recommendations for building a strong digital health infrastructure. Last week, Healthcare Innovation spoke with Eric Musser, vice president of federal affairs for NCQA, about the thinking behind some of the recommendations.
NCQA is a nonprofit, independent organization that works to improve healthcare quality through measurement, transparency and accountability.
Healthcare Innovation: A lot of the focus in your recommendations was about building a strong digital health infrastructure. If we look back at the Biden administration, can you point to a few examples of good progress on that front and perhaps a few missed opportunities?
Musser: I think digital quality has been a pretty nonpartisan issue over many administrations. In the last administration, they did a great job to bring folks together around TEFCA. They started thinking about healthcare operations and quality under that framework, which I think was a great opportunity to think about use cases for interoperability, with quality measurement being one of them.
I think some missed opportunities were around some of the eCQM [electronic clinical quality measure] reporting, and I honestly don't think it was the fault of CMS. I just think it's a reality of where the industry is with technology and the ability to aggregate data for various use cases. The ACO program had some stumbles with eCQM reporting, but I think that people still see the value in moving in that direction, and even this administration, I think, will push that agenda forward.
HCI: I remember attending several NAACOS conferences where many ACO leaders complained that digital quality measure requirements were being introduced too rapidly. But to me, your report sounds like NCQA is disappointed about the rate at which digital quality measures are being introduced in federal programs.
Musser: What we've seen is the evolving timeline and mandates from the federal government, and I think that affects the impact of investment to realize the potential. So if there was disappointment in the tone, I would say it was more around the wavering commitment at times, and the goal post moving at times for when the expectations for digital reporting might be, and also industry dragging their feet at times.
HCI: This also carries over to pushing FHIR adoption. You know, I would guess that Micky Tripathy and the folks at ONC would have bragged about their impact on FHIR adoption, but I would say your report describes the pace as somewhat underwhelming.
Musser: I think that policymakers have definitely committed to that as the future. There are the proposed rules that just came out on Friday across the facility programs. There's an RFI about digital quality measures, committing to FHIR for reporting to reduce burden. I think everyone sees FHIR as the future, and I think while we made progress, the shifting timelines for mandates has driven some delays in adoption on the ground in terms of having organizations be ready for implementing a FHIR-based reporting method.
HCI: You mentioned TEFCA earlier. I'm getting the impression that things are kind of in limbo there with all their meetings postponed, waiting for direction. Does NCQA have a position on whether continuing TEFCA is important?
Musser: I think the directional approach of TEFCA as a consensus-based process to get to national interoperability is a good approach. There are regional and local efforts for data standardization and interoperability that are also very valuable. The work to be done is to ensure that the infrastructure supports both moving forward. NCQA will continue to bring our strong, tested clinical science for quality measurement to whatever interoperability frameworks get finalized or approved at state or federal levels.
HCI: Do you have an idea of an achievable timeline for having a more robust digital quality measure reporting architecture in place? Is that something that can be done in two years? Five years?
Musser: We were very encouraged by the first Trump administration, which put a bold goal out there of 2025. That has since been moved to 2030, and I still think that that is doable and a goal worth driving towards. Whether that's everybody moving to that type of reporting environment, or that folks have the option for that level of reporting to invest in the technology to bring the efficiencies, then that's a very real goal.
HCI: What are some of the ways that NCQA is involved in driving some of those advancements in standards and interoperability and technology to pave the way for those digital quality measures?
Musser: NCQA is participating in those public/private partnerships like HL7 and other places where data is being standardized and implementation guides are being developed. When we see the need to help evolve the areas that relate to digital quality measurement, we’re standing up our own public/private partnerships with various stakeholders across the industry. We’re working with a variety of stakeholders on what we're calling the Digital Quality Implementers Community to help support digital quality measure reporting in the future. We're also looking at some of the technologies that were required under the Cures Act for bulk FHIR transport. We're working with various cohorts to look at the data coming from those Cures Act-mandated APIs to see what's the validity and accuracy of the data living in those APIs for digital quality reporting.
HCI: NCQA also recommended that HHS accelerate alignment with the CMS Universal foundation across HHS quality reporting and value-based payment programs. Could you talk about why that's important?
Musser: That is an initiative that's been at CMS for maybe three or four years now that recognizes the value of identifying a core set of quality measures that can be used across programs. I think that folks have realized that as value-based care models have proliferated, as quality rating systems and reporting consumer tools for quality have evolved, and as clinical science has continued to evolve, that more measures have sprawled. If you talk to health systems, they have spreadsheets of thousands of KPIs and other measures that they're looking at. I think CMS realized from a lot of stakeholder feedback that a more streamlined set of measures can help funnel resources and technology investment to help drive a smaller subset of measures that are aligned across the delivery system, all the way to population health and public health reporting.
HCI: The recommendations also calls for more effective use of patient-reported outcome measures. Has there already been some progress in including those in quality reporting, and does there need to be more work on standardization of the data or how the data is collected and reported before that can be more widespread?
Musser: There have been some efforts to date on patient-reported outcome measures. I would agree that is in the early stages of adoption in programs. NCQA has been on a decade-long journey around our person-centered outcome measures, and has tested them across provider settings. There are some that are ready to be implemented in federal and state-level programs, and we're seeing some promising results from some of those state level implementations.
HCI: Let’s switch over to the Center for Medicare & Medicaid Innovation. The NCQA report mentions what I think the new CMMI team and some in Congress have noted before — that the models, by and large, weren't saving taxpayers money. They've already canceled a few of the models early, including ones involving primary care. So could you summarize NCQA’s thinking about how CMMI should refocus their efforts?
Musser: I think that the innovation piece of CMMI really should come through in this administration. CMMI has the potential to help folks have more dynamic care plans where providers are seeing opportunities to intervene faster based off of the larger scale data they're able to analyze. I think that’s really getting to the heart of what the mission and vision of CMMI is. It should have the ability to be flexible in the way it updates its programs, or even in how it's designing its models, so that we are testing and providing the evidence for whatever the latest innovation in American healthcare is. I would say that many models have proven to be successful. Even though they haven't potentially garnered cost savings, we have seen opportunities where quality has improved. As they're rethinking models, I think it's really important for CMMI to think about how incentives are aligned to support both quality and cost savings, which is the fundamental goal of the agency.
HCI: NCQA urged the administration to collaborate with Congress to appropriate funds to incentivize behavioral health providers to adopt certified EHRs. They were left out of Meaningful Use incentives many years ago. Why is it important now? And how likely do you think that is in the current political environment?
Musser: It is extremely important that behavioral health providers have the opportunity to adopt technology to make the way in which they operate more efficient and provide additional value for them. As we think about integrating behavioral health more broadly into American healthcare, those technology and data investments are crucial. I don't have a perspective on how likely it is in the current environment. I do believe that behavioral health is a bipartisan issue. I think the first Trump administration did a strong job focusing on the opioid epidemic, so I’m hopeful that we find opportunities — whether it's through CMMI models or through other means — to bring additional funds and incentives for adopting technology.
