Through the successful completion of the NCQA Data Aggregator Validation Program pilot, we’re helping streamline HEDIS review for both payers and providers.
For years, Hixny’s goal has been to provide a service that brings all parts of the healthcare community together. While we’ve largely been focused on increasing our usefulness and trustworthiness to providers, as the core users of the health information network (HIN) on a daily basis, this year, we were able to take a major step forward in improving Hixny’s offerings to payers, whom you may know better as health insurers.
To this point, payers have largely used Hixny’s population health service and access to patient records to support their care management programs. However, the potential existed for Hixny to serve as a significant source of aggregated data that could help payers report on the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS), which is the industrywide standard of measurement for quality in healthcare—if data in the HIN could be validated for HEDIS use by the NCQA. Payers are ranked by the NCQA based on how well they and their participating providers meet HEDIS standards—and they are re-evaluated annually.
For decades, the HEDIS review process has relied on costly, individual chart checks. Payer staff have requested files—or gone to provider locations to inspect files—every year between January and May. The process didn’t change significantly when providers moved from paper charts to electronic health records (EHRs). Both on the payer side and the provider side, it’s been time-consuming, disruptive and arduous.
As more and more providers signed on to share records through HINs like Hixny, it became apparent that these could serve as “one-stop” sources for all of the information contained in charts that had to be mined during HEDIS review season. There was only one hitch: The NCQA and HEDIS auditors could not accept that data because it hadn’t been validated against the primary source—that is, each patient’s chart. So, there was no efficiency in pulling the aggregated information from Hixny, since the payers still had to complete chart reviews with each of their participating providers to validate that data.
In October 2020, Hixny earned the ability to publicize our successful program completion.
NCQA DATA AGGREGATOR VALIDATION
For several years, the NCQA has been heavily focused on leveraging electronic data, first through EHRs instead of paper charts and then considering what role data aggregators, such as HINs like Hixny, might play in HEDIS reviews. They developed measures that rely on the HEDIS Electronic Clinical Data System (ECDS), which dovetailed with the maturation of HINs in the quality and completeness of contributed data, creating tremendous efficiency for both health plans and providers over direct EHR access.
In the process, it became clear that validating the way providers entered data into their EHRs (primary source verification), and how that data flowed through the HIN, was the critical step that would allow payers to pull the aggregated data without having to re-verify that the information was correct. When the NCQA set out to pilot its Data Aggregator Validation Program, it was clear that Hixny—as one of the leading HINs in the country—would be onboard, along with two other HINs in New York.
In November 2019, we met with NCQA representatives to scope our participation in the pilot. Although the program was largely blind to our users at that time, the NCQA went through every process Hixny uses to touch data—from the way data comes into the HIN, to the ways we handle patient consent, to the ways providers access the data. They validated that our documented processes were, in fact, the processes we followed. Then they provided feedback and requested some changes to ensure those processes would maintain their rigor.
The part of the process that was evident to our users was the primary source verification of all 273 pipelines of data flowing into the HIN. We not only had to document the workflows users followed to enter information into their EHRs and where it was stored within those databases, but how that information flowed into Hixny, and then, how every necessary element flows out to the payers for their reporting to NCQA in the organization’s specified format. The resulting output is perfectly aligned with NCQA requirements.
Some 95 percent of Hixny data contributors passed the primary source verification, which was an exceptional rate for the number of facilities evaluated. Those who did not pass, in some cases, were not contributing enough information needed by NCQA. In other cases, their data entry processes were not rigorous enough to ensure that the output would maintain the accuracy necessary for HEDIS reporting. To help any of these organizations who wish to meet the primary source verification requirements, Hixny is providing workflow documentation assistance and advice.
The Payer Response
All three of eastern New York’s most prominent health insurers had a hand in the data aggregator validation pilot and look forward to the potential presented by Hixny’s successful completion of the program.
RENÉE GOLDERMAN
Senior Vice President and Chief Quality Officer at CDPHP
“What’s important to CDPHP is the need to leverage technology. That’s never been more important to healthcare. We use HEDIS for quality improvement—and this data aggregation improves our ease of access to quality data. We want to be focused on care, not on gathering data from EHRs, so we’re very excited about having this data flow.”
PATRICK ROOHAN
Vice President, Data Science at MVP Health Care
“This is huge step forward. It’s a win for the health plans, clearly, with fewer chart reviews and less money spent on those tasks. It will help providers, too. At times, we’re physically in their offices and it’s a pain for them. I also read an article recently that said it costs $15 billion on the provider side, nationally, to collect this data. Even for me, as a measurement guy, that’s a lot of money. So even though the provider has to complete the process of primary source verification with Hixny, the benefits of doing that outweigh the challenges of having to support each health plan’s HEDIS data collection individually.”
JEREMIAH M. BENOIT, MD
Medical Director at BlueShield Northeastern NY
“This has been one of our biggest priorities, as a payer, in our involvement with Hixny. It was quite impressive for Hixny to pursue this even through the challenges posed by COVID-19. The outcomes of the primary source verification were much better than I’d expected, and it’s been a good move toward reducing redundancy in healthcare data collection.”
