Digital Quality Summit
July 25, 2019

3 takeaways from the NCQA Digital Quality Summit

By Josh Holmes, Vice President of Business Development, Payer Markets, Apervita

It’s no accident that NCQA’s release of eight digital HEDIS® measures coincided with its Digital Quality Summit last week. NCQA is moving in parallel with The Centers for Medicare and Medicaid Services’ (CMS) move to electronic clinical quality measures (eCQMS). The summit centered around the move to digital HEDIS and the benefits of digital quality not just for payers but also, importantly, for patients. With attendance up nearly 50 percent YoY, the appetite for digital quality knowledge is stronger than ever. Below is my take on the top themes from the summit.

1. Payers are hungry for a digital quality roadmap.

Payers are at the beginning of the digital quality journey. They understand the larger promise of the HL7® data standard Fast Healthcare Interoperability Resources (FHIR), but aren’t entirely sure of how to leverage it along with the rest of the alphabet soup floating around: CQL (clinical quality language), SQL (structured query language), QRDA (quality reporting document architecture), CDS (clinical decision support), CCD (continuity of care document), ML/AI (machine learning/artificial intelligence), ECDS (electronic clinical data systems), NLP (natural language processing), and more. 

Aligning these technology standards, languages and solutions with payers’ high priority challenges is one place to start. For example, automating back-office processes with NLP and CQL can solve for resource constraints, while working with cloud platforms to run these programs can help engage and optimize better payer-provider collaboration. Workflow integration, as always, was a looming question. FHIR can solve for interoperability challenges but needs to be implemented correctly with cloud technology to be effective.

2. CQL’s potential is just starting to be realized.

Clinical quality language (CQL) has transformative potential for payers and providers alike. The HL7 expression language brings together electronic clinical quality measures (eCQMs) and clinical decision support (CDS) with one industry standard language. CQL allows for “shared math” between payers and providers—clinical quality can be measured on more than just claims data and improved with workflow-enabled insights. NCQA’s newly-released digital HEDIS measures bundle comes with a CQL package. The challenge lies in running and executing CQL, which requires a CQL-enabled cloud platform. In our experience, EHRs aren’t able to entirely support the full power of CQL, and most vendors can’t either. Instead, they convert CQL to SQL, which introduces risk and keeps analytics in their black box. In order to get the most out of CQL, payers must disrupt from within by investing in technologies that easily and cost-efficiently execute CQL.

Natural language processing (NLP) was also discussed at the summit. NLP on its own is a powerful tool, but when combined with digital HEDIS and CQL can transform an organization’s quality program. Apervita is working with one nationally-recognized health system to reduce chart chase, bring more clinical data into measurement programs, and continuously assess quality data by using digital HEDIS with NLP, powered by CQL in the cloud. An NLP engine was used to read physician notes, turning unstructured data into structured data and automating chart pulling analysis. That data was then fed into a cloud-based measurement engine to automatically measure patient outcomes against 90+ HEDIS measures.

3. Patients and payers are getting on the same page.

The shift to value-based care incentivizes better patient outcomes, but not necessarily clinical or operational patient centricity. CMS Director for Quality Measurement and Value-Based Incentives Group Dr. Michelle Schreiber discussed how payers can empower patients as part of their digital quality programs in her “Advancing Healthcare Quality and Safety in the Digital Age” presentation. Now armed with digital quality tools, payers are able to use cloud technology to give patients easier access to health claims data, current in-network provider lists and coordinated coverage benefits. Patients can have more ownership of their data and gain insight into the providers that share data, not block it. As Dr. Schreiber outlines, all of this is good for payers. Patient empowerment strengthens the payer-patient relationship, helps patients understand their healthcare expenses, keeps them in-network and promotes better outcomes.

Digital transformation enables payers to fundamentally enhance their value to the partners and more importantly the patients they serve within their ecosystem. This year’s NCQA Digital Quality Summit brought payers one step closer to that transformation. 

Apervita is hosting a webinar about the payer digital transformation journey on Wednesday, July 31. Click here to register and learn how to leverage digital HEDIS, process automation and CQL to advance digital quality programs.

Follow Josh Holmes on LinkedIn here.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)