Provider Data Integration for Quality Measurement & Value-Based Care

Introduction

Health plans use clinical data to manage population health, reduce costs, improve outcomes, and address health disparities. NCQA is making substantial and ongoing changes to the HEDIS® Quality Measurement program, encouraging the use of clinical data to produce more timely, automated, and actionable information. NCQA’s “Digital Quality” strategy will be an important enabler of value-based care programs and has prompted many payers to accelerate their efforts to aggregate and analyze clinical data. 

This white paper identifies some of the immediate steps a health plan can take in preparing to use clinical data at scale, outlines the challenges health plans may encounter, and offers strategies for overcoming them.

Developing a Clinical Data Aggregation Strategy

Clinical data aggregation is crucial for scaling and innovating health plan operations such as quality measurement and improvement, care management, and risk adjustment. A clinical data aggregation strategy lets you support multiple uses of clinical data while avoiding silos and duplicative costs. Your strategy should align with leadership priorities and be supported by business stakeholders and information technology and analytics leaders. Leadership from senior managers and directors should be made aware of aggregated clinical data, encouraged to promote its use, and empowered to seek innovative use cases that benefit their own (and other) teams.