Digital Quality Measurement is Heating Up – Will you be ready?

1. What are the advantages of moving to digital measurement?

As we know, a key benefit of transitioning to digital quality measures involves the use of clinical data. However, we are still early in the evolution toward greater data interoperability, so the benefits of processing and deriving value from clinical data may initially seem mostly in the future. In fact, several key advantages of digital quality measurement do not require a significant increase in clinical data availability.

First, the transition to digital quality measurement provides access to all HEDIS measures—including new and modified ones—much earlier, in time to use them from the start of a new measurement year. That means you can quickly understand how you’re performing and have time to adapt your programs and data sources, seeing impact within the same measurement year.

Second, digital quality measurement is more efficient and less costly. You can expect the total cost of ownership of a digital HEDIS engine to be lower than that of a traditional engine.

Third, digital quality measures offer easy customization of measure logic. This broadens the platform’s use beyond HEDIS reporting to quality improvement and state measurement use cases.

Fourth, digital quality engines can be expected to update their rates daily or even in near real-time. This means you’ll have up-to-date information to improve your QI activities and reduce member and provider abrasion through better data.

Taken together, these value propositions provide a strong ROI foundation that will only grow as clinical data (including FHIR data) becomes more widely available.

Read more:
NCQA explains Why Digital Quality? 

2. Can you help us understand the NCQA Timeline? 

NCQA has gradually altered its HEDIS timelines over the past few years in preparation for the digital transition. We now have a much clearer picture of what’s coming and how it will compare to the traditional timeline. The key differentiator in the digital timeline is that vendors can release CQL-based measures to customers much earlier (possibly up to 6 months in advance), in time for a full prospective measurement year. While many plans previously reused last year’s logic and adjusted dates, this only works when measures remain largely unchanged. However, HEDIS measures (including Star measures) are changing rapidly, and we expect this to continue under the new administration and its evolving priorities.

Enabling a full prospective year of measurement, analysis, and quality improvement is a major advantage of the digital timeline. Be mindful that this benefit applies only to vendors using the CQL measures as intended—with a native FHIR/CQL engine.

Learn more:
Digital Quality Transition Update (NCQA presentation from November 2024)

3. What does this mean for my existing HEDIS engine(s)?

NCQA’s guidance indicates that all plans will have an implementation year during which they must parallel report both digital and traditional rates. This year is not fixed—you can select your implementation year as long as it occurs before the retirement of traditional measures (expected in 2030). During this implementation year, you can expect to run both your digital and traditional engines. If your current vendor offers a digital HEDIS engine, you can coordinate with them to set your implementation timeline. If not, you may want to begin evaluating other vendors immediately. As 2030 gets closer, the risk of this transition will grow substantially.

Read more:
NCQA Guidance for Digital HEDIS reporting 

4. What about State measures?

Probably one of the biggest open questions remaining is State measures. We know that in many cases, state measures are similar or identical to HEDIS measures. But there are also unique State measures. We do not expect an immediate solution to this problem. Instead, we think that the market will evolve towards vendors offering CQL measures that encode the required state measures, even when the specific states in question or another regulator does not offer them in native CQL. Astrata will supply State measures and can also offer you the opportunity to upload and run your own custom CQL measures, which better positions you to move to a single HEDIS engine as soon as that’s feasible. 

5. What options do I have for meeting the 2030 date?

Some larger national health plans are building their own internal technologies and HEDIS engines. We expect that this will be a costly endeavor given the state of current technology, and we don’t recommend it for all health plans. Health plans that are considering a build-first strategy may want to determine how they will support the entire end-to-end HEDIS process. In particular, they should be attuned to issues of scaling measure computation and the costs associated with this scaling. 

6. How long will this transition take our organization?

It’s still uncertain how much time health plans should allocate for a complete transition. We believe a reasonable assumption is at least twice the duration of a standard HEDIS engine switch. That’s because:

1. This transition requires mapping to the FHIR Implementation Guide, which is more time-consuming than typical conversions to change HEDIS engines.

2. The measures themselves are different from traditional ones, requiring significant investigation and comparison. Plans should expect these processes to take longer.

7. What are the risks if I wait too long?

The biggest risk is running out of time to complete the transition. Another is that many health plans may wait until the last minute, increasing competition for a limited number of vendor resources.

There’s also a more subtle risk: delaying the benefits of digital quality (see question #1). Lastly, as clinical data (including FHIR) becomes more available, you’ll fall further behind in building the foundational infrastructure to leverage it effectively.

8. Where do prospective HEDIS medical record review and NLP fit in?

In response to the retirement of hybrid measures, most health plans have operationalized a prospective HEDIS medical record review process, often for a subset of at-risk measures. An NLP-driven process can help scale this review.

During the transition, we believe NLP-powered prospective review will be a key success factor. This approach leverages familiar data sources and existing teams and processes. As more structured data becomes available, we expect a balance between structured and unstructured data use. However, some HEDIS measures will likely still require unstructured data, NLP, and prospective review. Ultimately, both data types will be needed to approximate a complete rate and to compensate for the hybrid methodology’s retirement.

Read more:
Six Reasons to Start Your Digital Transformation with Prospective HEDIS Review
Accelerating Quality Improvement with Astrata’s Digital Quality Solutions – Case study with CDPHP 

9. What has been Astrata’s experience with early adopters?

Astrata uses a phased adoption approach to the digital quality transition because the technology and regulatory framework are still maturing. Our experience shows that early adopters succeed more quickly when they:

• Focus on a small set of measures

• Use a highly iterative process

• Have a scalable CQL engine

• Work with expert partners who provide frequent, actionable feedback

Our engagements follow our digital quality maturity model, which defines the necessary skills and steps for progressing toward self-sufficiency. Our product is built to support your success in this transition.

Read more:
The Road to Digital Quality – Astrata’s Maturity Model Approach 

10. How can I get moving fast?

Astrata offers a low-cost assessment to help health plans build their business case for digital quality measurement. The assessment quantifies the opportunity for value in the short and medium term, and culminates in a set of recommendations, with timelines and success metrics.

We also offer a similar assessment for plans considering NLP to scale prospective HEDIS medical record review.

Read more:
New Product Alert – Readiness Assessments