To be effective, quality measurements must be available at the point of care to better inform decision making. Many claims-based quality measures, such as the Patient Safety Indicators, have a 12-month lag between the end of the care delivery period and the reporting to hospitals on their performance. Non–claims-based measures, such as hospital-acquired infection measures, also have long delays, making the information less actionable. For feedback to work it must be timely and provide an opportunity to learn and improve.
At the moment, defined performance measures are non-existent. Access to a rapid tool for identifying and disseminating a standardized way of collecting data about new types of clinical information, however, could enable health systems to understand and improve performance.
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In another important area, Healthcare Effectiveness Data and Information Set (HEDIS) measures, which are used by 90% of health plans in the country for health care performance measurement, can ensure that payers are collecting and analyzing data as it relates to their performance. In fact, a number of payers started using value-based reimbursement models to help meet HEDIS benchmarks.
The newly released guidance eliminates the requirement for Medicare Advantage (MA) plans to submit HEDIS 2020 data (for 2019 dates of service), because of the burden placed on health care workers. Instead, CMS will use last year’s performance (measure-level rates and ratings, based on 2018 performance) for the 2021 Star ratings.
Choosing an effective clinical data connectivity solution
It’s important to find a point-of-care solution that can effectively identify open care gaps for proactive closure and provide payer-agnostic data to inform clinical, quality and risk adjustment programs for improvements in quality, risk adjustment scores and patient outcomes.
Stakeholders should also seek a solution with a robust HEDIS engine that is certified by the National Committee for Quality Assurance (NCQA) for all measures and refreshed annually for the most accurate data. This type of solution is critical for facilitating the transition to value-based care because it can meet the need for a complete interoperable clinical data connectivity solution that aligns the payer, provider and patient in a way that proactively closes care gaps, ensures visibility into the patient’s complete health status and manages utilization to foster better care planning and improve health outcomes.