HEDIS measures, ECDS and telehealth: Are health plans ready?

According to the National Committee for Quality Assurance (NCQA), the Electronic Clinical Data Systems (ECDS) reporting standard represents a step forward in adapting the Healthcare Effectiveness Data and Information Set (HEDIS®) to accommodate the expansive information available in electronic clinical data sets for quality improvement.* In addition, the growing use of telehealth reflects overall health care trends that place patient care and experience at the center of treatment decisions.

Optum held another webinar in “The Path to Risk and Quality Success” monthly series. The title was, “HEDIS® Modernization: How to Prepare for the Next Frontier of HEDIS.” Optum Advisory Services quality practice lead, Mallory Van Horn, and Brandon Taylor, director of Optum Risk, Clinical and Quality Solutions, shared thoughts on how advancing electronic data capture and telehealth are helping to shape the future of quality measurement and reporting.

NCQA* is proposing to convert 55 existing HEDIS measures to ECDS by 2022. It is anticipated in the next three to five years that there will be mandatory compliance for electronic submission. Consistent with their digital measure strategy, NCQA is adding ECDS measures each year over the next three years. NCQA proposes to convert existing HEDIS measures to digital (ECDS).*

  • HEDIS 2020 (July 2019 release) — 25 measures
  • HEDIS 2021 (July 2020 release) — 50 measures
  • HEDIS 2022 (July 2021 release) — 55 measures

Do health plans feel prepared for ECDS?

We asked health plan attendees if their organization is prepared for a future transition to ECDS. Of the 200-plus attendees, almost half felt they were prepared or somewhat prepared. When polled if they had a plan in place to support a transition to digital quality measurement, a little over 53% did not.

A little more than half of health plan attendees said their organization reported at least one or more ECDS measures in the 2019 HEDIS season. For the 2020 HEDIS season, the percentage raised to a little over 77% of health plans planning to report one or more ECDS measures.

DId Your Organization report at least one

Of telehealth and HEDIS measures
Telehealth is the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services and self-care via telecommunications and digital communication technologies. In practice, it is an option for both health care consumers and health care providers who want improved access to health services and greater scheduling flexibility.

More than 70% of health plan attendees reported using telehealth in some way, shape or form today. However, when asked whether participants felt prepared to leverage telehealth services for HEDIS measures in the future, a little less than one-third felt they were either prepared or somewhat prepared.

Take these seven steps toward HEDIS modernization now
History indicates ECDS reporting is likely the way of the future, so don’t get caught playing “catch up” with ECDS reporting. Because digital measures and telehealth are advancing rapidly, include telehealth as part of your strategic plan for clinical data integration. The competitive landscape does not allow time to fall behind, so ensure that you set up your organization for success.

  1. Establish a formal strategy for clinical data integration.
  2. Evaluate your infrastructure for the capability to exchange data with providers and acquire data from various sources (EHR, EMR, HIE, ADTs, etc.).
  3. Have a dedicated data acquisition program.
  4. Have strong member referential attribution logic for integration of electronic clinical data.
  5. Formulate both short- and long-term telehealth strategies.
  6. Evaluate resources and skill sets to be sure they can understand technical specification changes and support telehealth capability.
  7. Educate and cross-train for an understanding of how the clinical data is being captured to support integration of data.

Optum can help
Over 61% of attendees asked to learn more about Optum solutions for the 2020 HEDIS season. Whether you have a plan in place or want to move toward HEDIS modernization but don’t know where to begin, Optum Advisory Services can assist wherever your health plan is in the journey toward HEDIS modernization.

On-demand and upcoming webinars
Please visit The Path to Risk and Quality Success webinar series page to explore upcoming topics, register for the next monthly webinar or watch one of our other webinars in this series on-demand .

If you were unable to attend the webinar on HEDIS modernization or one of our other webinars in this series, you may watch on-demand.

 

*National Committee for Quality Assurance (NCQA). ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

 

Meet the Authors

brandontaylorheadshot.jpgBrandon Taylor, JD, MBA
Director of Risk, Clinical and Quality Solutions

Brandon Taylor is responsible for Growth and Strategy of Risk and Quality solutions at Optum. Brandon’s expertise includes HEDIS, risk adjustment and Stars Ratings strategy, health care interoperability, Health Law, population health management, and business transformation. Brandon was instrumental in assisting the first publicly traded national plan to earn a five-star rating.

 

Mallory Van HornMallory Van Horn
Practice Lead, Quality Improvement

Mallory Van Horn is the Quality Practice lead for Optum Advisory Services. The Quality practice focuses on assessing, designing, implementing, and launching Quality Improvement and Quality Management and Performance business solutions for Commercial, Medicare and Medicaid products. Mallory’s area of expertise includes HEDIS, CAHPS, Star Ratings and Accreditation with a particular focus on clinical quality measurement and reporting, state regulatory quality reporting requirements, administrative data improvement strategies and compliance audits.

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