NCQA Data Aggregator Validation (DAV): An ROI Analysis for HIEs

October 14, 2022

Article Summary


HIEs will learn how becoming DAV certified, or aligning with a Certified Data Partner, can expand revenue opportunities and reduce the time commitment required of health plans and providers for HEDIS quality measure reporting. 

health information exchange

Each year, U.S. physician practices in four common specialties spend an average of 785 hours per physician and more than $15.4 billion dealing with reporting quality measures. The sheer volume of electronic health data is unmanageable for healthcare organizations that must validate aggregated clinical data for quality reporting initiatives like Healthcare Effectiveness Data and Information Set (HEDIS®).  

How can Health Information Exchanges (HIEs) offer a solution? Access to Data Aggregator Validation (DAV) data that does not require primary source verification (PSV) is extremely valuable to health plans and providers. 

A Certified Data Partner offers organizations the opportunity to cut through the data aggregation complexity to easily validate data streams and deliver value faster—something HIEs can prove for long-term sustainability. KPI Ninja by Health Catalyst™ is an NCQA DAV Certified Data Partner, and this designation can extend to HIEs in their mission to provide high-quality community data for better healthcare delivery.   

A Certified Data Partner Offers Value to HIEs 

According to NCQA, a Certified Data Partner is “an organization that does not have legal access to data to conduct primary source verification but may meet other DAV standards and supports responsible parties for validation of the data stream.” In other words, a technology partner that supports an organization’s data flow, whether that be processing inbound messages, applying data transformations, or generating the output files that are passed on to the health plans. 

Earning NCQA DAV status includes strategic preparation, completing rigorous requirements, tight timelines, and dependencies on data participants. Becoming DAV-certified or leveraging DAV-certified technology benefits HIEs in several ways: 

  1. Modernizes data and quality reporting efforts. 
  2. Improves trust between stakeholders in HIE data quality.
  3. Maximizes their technology offering—and value—to health plans and providers.  
  4. Creates a revenue stream by increasing participants who want to reduce the time and effort spent on manual data validation.  

For example, WISHIN was among the first HIEs in the nation to earn NCQA DAV status. Their achievement has positively impacted HEDIS performance, increasing the administrative rate for numerous measures by more than 10 points in the first year.  

WISHIN chose KPI Ninja by Health Catalyst to validate WISHIN healthcare provider and practice participant data streams for its own DAV certification. As a result, several WISHIN health plan participants looked to WISHIN to shortcut the HEDIS “chart chase” and acquire primary source verified supplemental data to streamline data collection efforts, ensure data integrity, and reduce costs. 

“KPI Ninja brings technical expertise and innovation that directly supported our success in achieving NCQA Data Aggregator Validation status. KPI Ninja is a leader in advancing value-based care, and we are proud to partner with KPI to enable better health outcomes.”

– Joe Kachelski, CEO, WISHIN 

DAV Certification Improves Data Integrity  

One important DAV standard is CCD generation, as this is the file format that organizations use to share their DAV-validated data to health plans. 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. If HIEs do not have this capability or want to be assured of the ability to pass this standard, aligning with a Certified Data Partner will help meet this standard. 

“When organizations like KPI Ninja by Health Catalyst participate in NCQA’s DAV program, it shows they meet and demonstrate rigorous standards that drive clinical data integrity. This builds trust and creates more usable, valuable clinical data for health plans, providers, and their partners to improve the quality of care for the people they serve.”

Brad Ryan, MD, Chief Product Officer of NCQA. 

By leveraging the services of KPI Ninja by Health Catalyst, WISHIN demonstrated that supplemental data from certified ingestion sites maintained data integrity and met the criteria for NCQA DAV standards. 

More than 40 data sources in the WISHIN network, including data from multiple EMRs, inpatient and outpatient care settings, lab, imaging, and diagnostic data, were validated by the NCQA—allowing for the use of DAV data as standard supplemental data for HEDIS reporting. 

A Clear ROI for HIEs  

Offering validated data to health plans is a significant value-add when assessing a return on investment for HIE services. Now an NCQA-validated organization with more than 40 ingestion sites, WISHIN has improved the value of the data provided to its health plan participants. The return on investment includes the following: 

  • Substantially fewer labor hours required for manual chart reviews while positively impacting documentation of HEDIS performance. 
  • Reduced number of supplemental data sources for which health plans must get primary source verified. WISHIN’s health plan participants can use a single certified data stream. 
  • Reduced number of medical records that payers need to request from providers for HEDIS reporting. 
  • Health plan participants anticipate that leveraging the validated, automated data will lead to >10 percent increase in performance measures, including blood pressure control and hemoglobin A1c control. 
  • One health plan client shared that WISHIN provided the most supplemental data among all its supplemental data sources. 
  • WISHIN’s health plan participants can use the validated data for HEDIS reporting and improving their NCQA star rating. 

A Certified Data Partner eliminates some of the common struggles HIEs face in meeting emerging guidelines for data quality and delivers value to community-wide stakeholders.

 

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NCQA DAV Promotes Equitable and High-Value Healthcare 

Providers rely on validated data to improve quality measures, which have a direct impact on value-based care delivery across all patient populations. Many additional health plan participants have contracted with WISHIN to use the validated data for future reporting. WISHIN is also exploring its role in supporting health plan participants’ applications for NCQA Health Equity Accreditation and in meeting health equity measures, further leveraging certified data to improve health equity.  

Many HIEs like yours are at various levels of sophistication when it comes to data aggregation and transformation. We here at KPI Ninja by Health Catalyst offer a variety of solutions to make high-quality data attainable for our nation’s HIEs. We look forward to supporting your exchange in becoming the go-to resource in your community for certified data.  

Additional Reading 

Would you like to learn more about this topic? Here are some articles we suggest: 

How to Reduce Unwarranted Care Variation in Patients with Heart Failure – Part 1

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