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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.
--------------------------------------------------------------------------------
JUMP TO:
HEDIS MEASURE REPORTING COMES AT A COST
STREAMLINING REPORTING EFFORTS WHILE MAINTAINING STANDARDS
IMPROVING DATA: THE PARTNERSHIP WITH KPI NINJA
RESULTS
WHAT’S NEXT
DOWNLOADS
Validated Data Improves HEDIS Measure ReportingDownload +
UP NEXT:
REPORTING EFFICIENCIES YIELD SAVINGS AND IMPROVED SATISFACTION
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
* The Future of Healthcare: Our Promise to HIEs
* KPI Ninja by Health Catalyst™
* Efficient Exchange of Data Improves Alternate Care Site Patient Transfers
Increasing Capacity for COVID-19 Surge
* Certified Analytics Platform Enables Electronic Quality Measures Reporting
* The Top Seven Healthcare Outcome Measures and Three Measurement Essentials
Reporting Efficiencies Yield Savings and Improved Satisfaction
Group 37
TRANSFORMING HEALTHCARE IS OUR PASSION
Health Catalyst is a leading provider of data and analytics technology and
services to healthcare organizations, committed to being the catalyst for
massive, measurable, data-informed healthcare improvement.
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