Validated Data Improves HEDIS® Measure Reporting

September 7, 2022
Posted in Data and Analytics

Article Summary


Reporting quality measures costs healthcare organizations billions annually. To help reduce costs associated with reporting efforts, WISHIN partnered with KPI Ninja, an NCQA Data Aggregator Validation (DAV) Certified Data Partner, 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 Healthcare Effectiveness Data and Information Set (HEDIS) “chart chase” and acquire primary source verified supplemental data to streamline data collection efforts, ensure data integrity, and reduce costs.

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Featured Outcomes
  • Substantially less staff time required for manual “chart chase” and review.
  • Positively impacted HEDIS performance, increasing the administrative rate for numerous measures by >10 points in the first year.
  • WISHIN was among the first health information exchanges (HIEs) in the nation to earn NCQA DAV status and has improved the value of the data provided to its health plan participants.

HEDIS MEASURE REPORTING COMES AT A COST

HEDIS, used widely by health plans, gauges the quality of healthcare services. Reporting quality measures costs U.S. physician practices more than $15.4 billion annually.1 WISHIN sought to reduce the time, effort, and costs associated with its provider and payer participants’ HEDIS reporting efforts.

STREAMLINING REPORTING EFFORTS WHILE MAINTAINING STANDARDS

Several WISHIN health plan participants used WISHIN as a supplemental data source to support comprehensive HEDIS measure reporting. WISHIN continually supports its participants by making comprehensive clinical data from its broad network available to improve HEDIS reporting. WISHIN’s role is to take on the burden of primary source verification while helping to ensure health plans maintain the highest possible NCQA star ratings.

Health plans and healthcare provider organizations are seeking emerging solutions and technology to reduce supplemental data acquisition and reporting costs while simultaneously ensuring high-quality, accurate data review and reporting. The solution is leveraging WISHIN’s DAV certification.

IMPROVING DATA: THE PARTNERSHIP WITH KPI NINJA

Prior to achieving DAV certification, WISHIN looked to KPI Ninja, an NCQA Certified Data Partner, to improve non-standard supplemental data reporting for its participants. The partnership with KPI Ninja ensured proper validation of WISHIN data sources and automated delivery of non-standard supplemental data submission. This led to seamless continuity when it came to DAV certification – data validation, data structure, and delivery.

By leveraging the services of KPI Ninja, WISHIN was able to demonstrate 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.

WISHIN’s health plan clients can now use primary source verified supplemental data from the validated sources in the WISHIN systems to support their HEDIS submissions without having to access the data from individual providers.

“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

RESULTS

WISHIN was among the first HIEs in the nation to earn NCQA DAV status. 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:

  • 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.

WHAT’S NEXT

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. WISHIN is engaged with NCQA as part of DAV cohort four to recertify previously certified ingestion sites and include even more sites for validation.

REFERENCES

  1. Casalino, L. P., et al. (2016). US physician practices spend more than $15.4 billion annually to report quality measures. Health Affairs (Project Hope), 35(3), 401–406. Retrieved from https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1258

ADDITIONAL READING

Reporting Efficiencies Yield Savings and Improved Satisfaction

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