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Key Takeaways from the NCQA Health Innovation Summit 2022

The NCQA Health Innovation Summit for 2022 was held in Washington DC last week and was nearly 4 full days packed with education, networking & fun! Some of the key themes and learnings that stood out from our visit are

  1. Health plans still relying on outdated technologies & not leveraging digital/FHIR technologies – While support for FHIR among provider EHRs has grown exponentially thanks to ONC (Cures Act) & CMS (Interoperability & Patient Access rule) enforced regulations, health plans haven't leveraged the potential of these capabilities yet – for example gap in care alerts into the point of care, or real-time clinical data collection use cases. Aneesh Chopra (ex-CTO, USA 2009-2012) exhorted the audience to let go of past technologies (Fax usage has only increased since the HITECH act – even though it didn’t need to was an example he stated) and adopt structured data exchanges – especially since key data needs for payers are already supported by majority of EHR vendors in the form of FHIR / SMART API calls. Alignment of data strategy with quality measurement has never been more important, as we seek to create meaningful point of care interventions that drive better health quality.
  2. Closest alignment yet between NCQA, CMS and ONC to adopt Digital Quality Measures (dQMs) – All of the key regulatory agencies demonstrated alignment towards adopting USCDI+QM as the base data set for all measures – MIPS, HEDIS etc. along with a move to fully digital MIPS program focused on value based care planned by 2028. This also aligns to when we expect NCQA to announce a transition from ECDS & Traditional / Hybrid approaches to the Digital Quality Measure (dQM) approach for the HEDIS program. CitiusTech expects further guidance and details around USCDI+QM to be published as part of the Jan 2023 release of USCDI by the ONC.

  3. Health Equity is a critical focus area for health plans & regulatory agencies alike – With Race and Ethnicity stratifications kicking off a new era for HEDIS reporting, health plans are focused on growing the breadth and depth of data coverage for equitable, personalized, holistic quality measurement. These include environmental, socio-economic, behavioral and environmental factors such as transportation access, familial living conditions, eating habits etc.

  4. NCQA initiatives continue to advance quality measurement – NCQA's MY2023 measure changes demonstrate NCQA's continued journey towards measure simplification, measure efficacy enhancement, health equity and ECDS + Digital transition. Additionally, NCQA initiatives like the Diabetes Recognition Program (DRP) Refresh align with FHIR driven interoperability and data sharing, expanded data sources such as devices / digital therapeutics, pharmacological, health equity focused analytics, and expanded clinical care delivery networks (closer to home) for influencing and driving improved outcomes. One of the lighter moments was when the NCQA and CMS presenters seemed to agree on the need for modifications to CAHPS & survey based member experience measurement that would include change to the high weights currently assigned to these in the CMS Star program

Overall, the conference made it abundantly clear that the healthcare industry is at an inflexion point where adoption of digital technologies can tangibly enable true interoperability and high quality outcomes for whole health.

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