Early Updates from the NCQA Digital Quality Solutions Pilot

The agency's chief product officer identifies first milestones and timetables in the transition from paper-based to digital quality measurement.

The NCQA's conversion of its printed quality measures manual to a software solution that supports digital quality measurement (dQM) is under way.

The pilot includes six payer, provider, and tech organizations, counts former ONC national coordinator Dr. Don Rucker as an executive lead, and will benefit from new CMS recognition that digital quality must move beyond paper-based standards and EHR-only data rooted in manual processes.

For the first of a three-part series on the pilot, HealthLeaders interviewed NCQA chief product officer Dr. Brad Ryan about why the pilot is unique as well as vital for continued healthcare transformation and value-based care (VBC) progress.

NCQA pilot overview

The Digital Quality Solutions pilot targets the NCQA's printed manual of HEDIS measures—the Healthcare Effectiveness Data and Information Set that the agency updates annually and uses, in part, to generate health plan ratings.

The pilot is unique in several ways.

"This is the first time that we have developed software as a primary product," says Ryan.

An NCQA press release adds two other pilot differentiators: "First, it uses 'agile' software development techniques that emphasize frequent iteration and steady input from users. Second, the project involves a range of organization types—helping diversify NCQA beyond its roots as a quality evaluator of health plans and physician practices." 

Diverse stakeholder participation is another new facet.

"We know that our HEDIS measures are getting used by organizations outside of the vendors and plans," says Ryan. "Provider organizations have value-based contracts, and this is a part of quality, but we haven't always engaged those parties so we're trying to do that for now for those delivery systems."

dQM market value and dynamics

As a printed publication, the NCQA's HEDIS manual binds quality measurement to a paper-based process which a cottage industry of vendors individually interprets and programs.

"You have teams of people who are clinically technical who take that paper specification and interpret it with their brain to put it into pure SQL or SAS or some kind of environment to turn it into a HEDIS engine," explains Ryan.

"That is being done by 100 different vendors, development teams, infrastructures, and data models," he adds, to make HEDIS computable.

The NCQA pilot will remove the repeatable manual processes of multiple vendors—"giving them an opportunity to revamp to a lower-cost model," says Ryan, through HEDIS software that will be modular, configurable, and more efficiently computable.

For these reasons, Ryan asserts that the NCQA software complements rather than competes with current HEDIS vendor offerings, with the agency acting more as a channel partner.

"I think the vendor community should be excited because it's an opportunity to evolve their business model."

Related: NCQA Publishes 2023 HEDIS Quality Measures Update

NCQA's rollout schedule

Since pilot launch, stakeholders have held initial meetings and the NCQA announced an in-development, digital transition playbook at its July Digital Quality Summit. The organization plans to preview its software by December 2022 and make a pilot product available to early adopters. That product will include a dQM subset aligned with the most common VBC measures.

"We'll be running two models [printed and dQM] for some time," says Ryan, adding that the NCQA wants to be all digital within the next four years.

"The transition is the hard part. We know partial dQM will be a challenge. The early adopters are those that would like to start learning, investing, and building out the infrastructure to support the new model earlier."

Transforming business models and tech approaches

Ryan acknowledges that quality has needed to migrate from a measurement to an improvement model to keep up with other kinds of healthcare transformation.

"There has been rapid change in terms of how healthcare is structuring itself. Older products fixed to more traditional care models," says Ryan, citing VBC, risk management, and emerging delivery systems rooted in telehealth.

"One of the things we're working on is how we can be more flexible to emerging business models. All of this been happening to some degree but through hard, friction-filled, wasteful effort," says Ryan. "There is an enormous opportunity to take both our existing portfolio of paper and people-based standards … and rethink what an assessment looks like in a digital world."

Even Ryan's chief product officer role is reflective of organizational and industry change. The NCQA created the position and hired Ryan for it in 2020. From the beginning, his objective was clear.

"We have an incredible opportunity to lead the transformation to deliver better measures to create more relevant insights at the point of care, ease the administrative burden for clinicians, and all at lower costs," said Ryan upon joining the NCQA.

CMS alignment will support dQM efforts

Before dQM, there was eCQM: Electronic Clinical Quality Measures. While eCQM still represents a step forward in the evolution from paper to digital quality, it has limitations. It is based on the EHR with manual processes still required for mapping data and updating clinical workflows. dQM is based on standardized data, including FHIR standards, that allow for automated data mapping, collection, and extraction. In addition, dQM data can be pulled from anywhere (e.g., patient registries and surveys, HIEs).

"In the time since we conceived of and launched the pilot, we have more alignment with CMS on dQM. They've started communicating a definition and benefits that align with pilot content," says Ryan, adding that CMS also recognizes the need for the kind of "dynamic, configurable software component" that his organization is building.

"It's an upgrade," emphasizes Ryan.