By: Lucy O’Connell and Eric Gunther
One of the foundational components of the Azara DRVS product is our library of clinical quality measures (CQMs). Previously we’ve talked about the variety of CQM specifications out in the wild, but perhaps the most commonly referenced are CMS’s eCQMs, which are publicly available. Not only does CMS provide CQM specifications to evaluate your clinical data, but through the ONC, they offer the ability for Azara to officially test and certify the CQMs we’ve built for your clinical data. Azara previously went through this certification process back in 2013 as part of the ONC’s 2014 edition criteria. More recently we re-tested under the 2015 edition criteria for the 2019 reporting year eCQMs.
Another commonly used measure specification is NCQA’s Health Effectiveness Data and Information Set (HEDIS®). We have been building HEDIS® measures in DRVS for the past few years to match the increasing importance of HEDIS® metrics in Medicaid value-based payment programs. As more healthcare segments join the DRVS community, our HEDIS® measures are finding even more use with more than 90% of US health plans (with over 190 million people enrolled in those plans) reporting quality results using HEDIS® metrics.
Unlike EHR-focused CQMs, HEDIS® measures are based around health plan claims data. We at Azara love integrating clinical data and health plan claims data because it gives a more comprehensive picture of quality performance than either clinical or claims data alone. Azara provides HEDIS® measures with integrated clinical data as well as health plan claims data so our partners can target and fill gaps in specific health plan data to realize their true quality performance on these measures.
Just this past month we completed our Measure Year 2021 HEDIS® certification for thirty-five 2021 reporting year measures. This is an increase from twelve HEDIS® measures certified for Measure Year 2020 six months ago–an increase made possible by scaling our development team and standardizing our testing processes (more about that below).
There’s a lot we could go into about the nuances of certification editions and measure versioning, but let’s keep it simple: for CQMs and HEDIS® measures, we work with a 3rd party (sometimes the organization who created the measure specifications themselves) to test that our measures are calculated correctly.
The Testing Process
For the CMS eCQMs, there are two options for testing—you can use ONC’s open source Cypress tool or you can use NCQA’s alternative test method. HEDIS® testing is done by the NCQA. After some difficulties using the Cypress tool in our first round of ONC certification, we decided to try the NCQA’s alternative test method for the eCQMs.
The testing process for both the eCQMs and HEDIS® is pretty straightforward. They provide test data via a web link, you import it into your system, calculate the measures, export the results, load the results into their test portal, then find out if you calculated the measures correctly. The NCQA’s testing process uses up to hundreds of thousands of test patients per measure which cover every branch of measure logic.
For example, the colorectal cancer screening measure has test patients who are too young, too old, have had colorectal cancer diagnosed in the past, have had a colonoscopy 11 years ago, have had a colonoscopy 9 years ago…and every combination of these criteria. For the eCQMs this test data is expressed using C-CDAs and for HEDIS® they use a proprietary data format—in both cases we load the data into our data warehouse then calculate the measures like we do for any of our CHC customers. For the eCQMs the export is done using QRDA, which you then upload to the NCQA’s portal. For HEDIS®, you use a proprietary format. Once you are passing the sample decks (which you know the answers to) you run the official test decks which you don’t have access to the answers for. Once you pass those, the rest is paperwork!
In the end, the vast majority of our measure logic was already sound and going through this rigorous certification process for both our eCQMs and HEDIS® measures was a lot of effort. But that testing and certification now provides a new level of confidence in our product and has left a lasting impact via improvements to our testing infrastructure. Now, after spending the better part of a year working on certification efforts, our reporting team is ready to move on to the next challenge!
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
NCQA HEDIS Health Plan Measure Certification Program™ is a trademark of the National Committee for Quality Assurance (NCQA).