HMA and NCQA’s recently hosted the webinar “Opportunities to Electronically Share Digital Quality Measurement Data With Stakeholders FHIR-Based Digital Quality Measures (dQM)”

Key Points from the webinar:

• NCQA confirmed its retirement timeline of the HEDIS hybrid measure sampling methodology: The transition to dQM necessitates the elimination of the hybrid methodology that lowers the burden of reporting by allowing payers to reduce measure eligible populations down to 411 members or events. The near real-time, prospective benefits of dQM can only be realized through reporting of measures’ eligible populations. This transition requires that payers assess the “hybrid lifts” of their measures and develop strategies to address data gaps. Enabling the APIs and data systems needed to exchange real-time, USCDI (United States Core Data for Interoperability) compliant FHIR data is critical to cost effectively close the data gaps.
• NCQA confirmed that FHIR is the consensus standard for data exchange and dQM. The adoption of Fast Healthcare Interoperability Resources (FHIR) APIs, mandated by CMS Interoperability and Patient Access Final Rule (CMS-9115-F), is the consensus standard for real-time data exchange required for Clinical Quality Language (CQL) reporting of dQMs.
• Over 90% of the FHIR and CQL information infrastructure is complete. Through progress on CMS’s Digital Quality Measurement Strategic Roadmap and NCQA’s commitment to reporting digital-only HEDIS measures, nearly all dQM required software components are ready to implement.
• NCQA has identified the PIQI (Patient Information Quality Improvement) Framework as the open-source standard for implementation of computable data quality metrics. PIQI prioritizes the development of DQ criteria for several HL7 standards, including FHIR USCDI Version 3. NCQA intends to replace inefficient primary source verification (PSV) with implementations of the PIQI standard, such as Velox partner Clinical Architecture’s PIQXL Gateway^TM, which generate data quality scorecards that provide actionable insights on the data quality criteria.
• All HEDIS measures will be digital only by January 2030 while Prior Authorization (CMS-0057-F) and Payer-to-Payer APIs must be implemented by January 2027. Meanwhile, a recent Firely survey found that 54% of payers do NOT have a FHIR transition plan. Stated differently, payers only have 17 months to complete mandated digital transformations of their clinical data operations and most don’t even have a plan!!