Exchanging Better: CCD Generation as part of NCQA’s Data Aggregator Validation

As our health care system moves closer to true interoperability, the universal hope is that these capabilities will be a catalyst to more affordable, high quality health care. It is an exciting time if you are a Health Information Exchange (HIE) that is equipped to handle the volume and diversity of health data to meet the growing value-based care needs. HIEs that achieve NCQA’s new Data Aggregator Validation (DAV) status is one such example.

The DAV program is capturing the attention of HIEs and health plans as it brings with it the kind of burden reduction that health plans, organizations and providers need to tip the scales to move focus from reporting to improving. As HIEs today face a myriad of data standards and formats, their flexibility to generate various file formats is challenged. NCQA’s DAV requires the generation of a Continuity of Care Document (CCD) to send validated HIE data to payers. Since this is not one of the customary file types that are generated, many are needing to build new capabilities internally or hire a trusted partner that can not only generate a CCD to standard for NCQA’s DAV but also meet the outbound requirements of any HIE participant or program.

HIE Data for HEDIS® Reporting

Health plans have traditionally looked to HIEs to deliver information about their patients that fill gaps that exist within their own datasets. Often the value is not just in the data, but that the data is timelier than lagging administrative claims and comprehensive, capturing health information across a wide net of care settings. A clear value proposition for a payer’s care management and quality teams looking to prevent and better manage patients’ health. But, what about using this valuable HIE data for HEDIS measurement and reporting?

NCQA’s DAV creates the opportunity for DAV-validated HIEs – that is HIEs that demonstrate the ability to maintain the integrity of the data from the original electronic health record system – to offer validated data to payers for their HEDIS reporting as standard supplemental data, eliminating the need for resource-intensive, primary source verification. But, before HIEs can offer this tremendous value, they must demonstrate adherence to NCQA’s robust requirements, with one of them being the ability to generate a CCD according to NCQA’s Implementation Guide.

NCQA checks that aggregators can produce a Continuity of Care Document (CCD) – data in a standardized format that the aggregator can pass to health plans for HEDIS reporting.
– NCQA DAV website

CCD Generation Requirement

A CCD is a HL7 file type, a communication standard, which various providers and care teams can use to share electronic health information across care settings without the loss of meaning to enable seamless care delivery. A “Super CCD” or a “Community CCD” that is built on the comprehensive HIE data set includes information that everyone in the care team needs to prevent, monitor, and improve health status. And this is precisely why it is the outbound data requirement of NCQA’s DAV.

While there have been rumors about future data exchange requirements, like FHIR or .txt files, here today NCQA’s DAV program requires that HIEs generate a CCD to NCQA’s Implementation Guide which is based on HL7 C-CDA R2.1. The requirements cover all the elements you would expect to generate a CCD with information to support quality measurement reporting. Sections and associated elements like encounters, functional status, immunizations, vital signs and more.

Benefit of a Data Partner

While some HIEs may have these technology capabilities internally, a partner can save you time and energy to achieve the CCD and other DAV standards.  Of note, NCQA’s DAV program is offering technology companies, like KPI Ninja, that is not the responsible party of the data but have capabilities to meet standards, the ability to get certified as a DAV Data Partner. Once certified on specific standards, HIEs looking to achieve DAV status can demonstrate use of a certified Data Partner and flow the benefit of the Data Partner’s certified standards to their own validation efforts. Hiring a good partner not only enables you to achieve DAV status easier and faster, but further enhances your ability to offer complex services that meet all your participants’ diverse needs.

If your desire as an HIE is to demonstrate your value to the region, then having NCQA’s DAV status can help. The vastness of DAV extends far beyond the direct benefits of your payers but in demonstrating the robustness of your HIE in meeting the growing value-based care data needs. Since KPI Ninja is in touch with value-based care and population health standards and programs, we have the right capabilities and expertise to help your HIE offer new value propositions to engage your participants at heightened levels.