Payer Impact on the NCQA Digital Quality Pilot: Q&A With Aetna's Sonja Hughes

Aetna is set to offer national scale, measures reporting, and plan complexity perspectives.

Digital health and value-based care (VBC) transformation both require digital quality measurement (dQM). The NCQA's Digital Quality Solutions pilot will culminate in the conversion of the organization's printed quality measures manual to a software solution that supports dQM.

Aetna, a CVS Health Company, and Health Care Service Corporation were the two payers chosen to "inform, test, and provide feedback on NCQA's initial Digital Quality Solutions product offering." Also noted in the pilot description, participants will be considered Digital Quality Solutions Trailblazers with the opportunity to be featured in case studies.

Dr. Sonja Hughes, Aetna VP of strategy and service excellence, shared her plan's motivation and qualifications for joining the pilot.

HealthLeaders: How do you see the current state of healthcare quality measurement and why is the NCQA pilot important?

Hughes: The COVID-19 pandemic accelerated the adoption of virtual care services and tools, including the importance of technology in facilitating caring for members. The NCQA Digital Quality Solutions pilot is designed to facilitate a way to explore how health plans can provide the information members and providers need—and want—through digital means and how they can exchange this information. 

I was a physician for 22 years before transitioning to managed care and quality outcomes. In my early years as an MD, everything had to be written down by hand, then transcribed. I've experienced and witnessed angst from different generations of physicians regarding the transition to EHRs. Flash forward to now, we have robust data that we can access and work with electronically.

As someone who has been in the trenches of these processes, digital tools like the NCQA software will make care timelier and leave less room for errors. These tools can relieve burdens across the healthcare system—ultimately leading to better health outcomes.

HL: Why do you believe Aetna was one of the payers chosen for the pilot?

Hughes: Aetna has a long-standing relationship with NCQA and was able to provide a diverse team with broad experience that makes us well positioned to be a trailblazer in digital quality. The end product of the pilot should be something that can be leveraged across the industry, and Aetna provides insight into the complexities based on our national member base and the data we can leverage.

HL: Why did you want to participate? What do you want to achieve? What unique role/perspectives does the payer contribute to the pilot compared to the others in the group?

Hughes: Our primary motivation for participating was ensuring that we foster better health outcomes and provide real-time education for the communities we serve. As an industry, we're on the right path to operability, but digital tools can increase access to care and address the unmet needs of patients. Through our participation, we want to ensure that the industry as a whole has the tools and resources necessary to make digital equality a reality. 

Aetna aims to contribute several unique perspectives to the program. First, we wanted to provide our perspective as a large, national plan. Considering the complexities of large national plans allows for the end product to be applicable to and leveraged by organizations, payers and companies across the board, regardless of size. We also wanted to provide our unique skill set with measures reporting. As a large payer, we possess rich digital data that can help inform a more connected and robust end product. Lastly, like other more extensive national health plans, we understand the complexities of having more than a single or multi-state plan. Leveraging that data is crucial for the success of the pilot. We're proud to be able to provide that.

HL: How will Aetna apply lessons learned from the pilot to its own initiatives?

Hughes: The Aetna team will analyze, inform, and provide feedback on NCQA's initial product offering. In addition, the participation will provide us with insight into what process changes may be impacted by digital measure solutions.

The entire healthcare industry recognizes a shift towards adopting more digital tools and services, and health plans, in particular, are aware that electronic measures are becoming increasingly important. Many health plans have begun the necessary infrastructure changes and investments needed to accommodate digital solutions. It is also an iterative process involving internal discussions where participating organizations provide NCQA feedback to inform the appropriate implementation of these solutions.

HL: Do you agree that payers can now expect more from providers in terms of outcomes?

Hughes: From a provider and payer perspective, I've been thinking about all that NCQA has done over the past decades, bringing together and measuring different aspects of healthcare for better outcomes. This program, and the solutions and framework that it aims to build, certainly have the ability to impact provider behavior. 

From my point of view, I reflect on what I would have or could have done differently if more digital information had been available when I was practicing. Even as advancements are made, it is imperative to consider the providers and recognize that we must be very thoughtful of how changes will impact their care of patients. In the end, the patient is the focus. Having the ability to access information that impacts better health outcomes is the ultimate goal.

Read the previous articles in the series, including HealthLeaders' interviews with NCQA chief product officer Dr. Brad Ryan and from pilot participant 1upHealth's leaders CEO Joe Gagnon and chief strategy officer Don Rucker.