Looking into “The Future of HEDIS”


Chun Li, PhD, Chief Data Scientist with Amy Krane, Director of Product Marketing

Our friends at NCQA have been educating the market on “the future of HEDIS®” in a series of webcasts and announcements over the past several months.

HEDIS measures are traditionally used for health plan reporting, as well as by health maintenance organizations that provide Medicare services. More than 190 million people in the United States are members of plans that report HEDIS results. So HEDIS is one of the most widely-used performance improvement tools. It’s also one of the oldest, with roots in the HMO world of the 90s. But that does not mean it’s stuck in the past.

We caught up with Diameter Health’s Chief Data Scientist, Chun Li, PhD, and asked her to help us understand what the future holds.

Chun, I’m going to start by asking you to define some terms for us. Can you explain what a Digital Measure is? Also, what are Electronic Clinical Data Systems (ECDS) and how do the two relate?

The simple way to think about it is that all ECDS measures are digital, but not all digital measures are ECDS.

Digital measures are simply digitized versions of existing HEDIS measures. NCQA provides machine-readable versions of measure logic, written in computer code. So instead of reading the narrative description of the measure and translating that to code in an IT system, the measure can be downloaded. When updates are made to the measure logic, the change can be automated in a system that can interpret digital measures. Digital measures avoid errors and reduce administrative overhead. But digital measures can still be reported using traditional means.

By contrast, ECDS is a reporting standard and promotes the collection of member information from electronic sources. Measures are calculated using electronic clinical data collected from electronic health records (EHRs), health information exchanges (HIEs), clinical research and disease registries, lab reports and pharmacy systems. NCQA encourages the use of multiple sources of data to get a full picture of the quality of services delivered to members. NCQA established the standard based on the fundamental principal that quality measurement should be more than just scoring, but a source for decision making. ECDS reporting is intended to generate insights for managing the health of individuals and groups. And measures that are computed from digital records have the added benefit of reducing the burden of reporting on providers.

What is the current status and what does the future look like when it comes to Digital Measures?

NCQA has digitized 19 out of the 88 non-survey measures (21.5%), with the most recent release being the 8 measures on Oct 31, 2019. They will continue to digitize more measures and we can expect that the future of HEDIS is digital. But from a practical perspective, not all HEDIS measures will be digitized. Some are harder to define programmatically, or the benefit is not clear.

What about ECDS?

The news on the ECDS front is that NCQA announced in September that the first measure to be publicly reported in 2021 based on the 2020 measure year is Prenatal Immunization Status (PRS). According to the NCQA, “public reporting of an ECDS measure is a critical step in the use of clinical data systems to measure quality.” ECDS reporting is optional in 2019 and fewer than 10% of payers are using that method. The rollout plan for mandatory reporting is not yet determined by the NCQA, but we think there might be a period of double reporting (traditional and ECDS) to ease the transition.

The ECDS initiative is especially exciting to us because, at Diameter Health, we are big proponents of using clinical data generated in the course of care for quality reporting.  This makes reporting more accurate and less burdensome. But more significantly, the results are timely and actionable for quality improvement.

Another byproduct of ECDS measures is that it reinforces the need for a bidirectional connection between payers and providers. Providers need to provide the source clinical data, and payers need to make the data accessible to the care team so they can work together to make the quality improvements suggested by performance on the measures.

Finally, ECDS brings eCQM — CMS’s ambulatory electronic clinical quality measures for providers — and HEDIS closer when it comes to measures that have a clinical component. This is because there are already so many data elements that overlap. Efforts that promote convergence of quality measures are helpful to streamline the quality reporting processes to ultimately making it a byproduct of care.

You’ve talked about what this means to payers and providers. Any implications for Diameter Health?

The future of HEDIS should drive the adoption of clinical data sources on the part of payers. Clinical data integration should replace the laborious, manual chart chasing that infuriates providers and is so costly to payers. So, although establishing a clinical data integration solution may be a challenge, it’s worth pursuing and indeed a necessity if payers want to be prepared for the future of HEDIS.

Diameter Health has an important role to play with in this scenario because if we are to rely increasingly on clinical data for HEDIS, those data need to be clean, normalized, and ready to incorporate into reporting systems.

Should payers be concerned?

Absolutely not. The whole goal is to modernize the HEDIS program and decrease the reporting burden. It’s also aimed at making quality measurement more than just reporting scores, and actually a way to improve quality. There will be some growing pains and a need for IT infrastructure. But any workflows and relationships that are already established – such as how laboratory data is acquired – will remain the same and can be built upon.

In fact, in the spirit of making sure that HEDIS can support actual quality improvement, the NCQA has also announced a schedule change for releasing HEDIS specifications. For 2021, the specifications will be released in the prior year (2020), rather than mid-year of the measurement year. This should make it a lot easier for payers to get an accurate picture of care gaps prospectively, providing time to close them before the end of measurement period. Acquiring timely clinical data from EHRs or HIEs will be a great strategy to fully leverage this information.

Where can we find additional information?

NCQA has articles and presentations here.

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

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