FHIR, Quality Measurement and Value-Based Care: What NCQA’s Ed Yurcisin Wants CIOs to Know

In a recent interview, Ed Yurcisin, Chief Technology Officer of the National Committee for Quality Assurance (NCQA), shed light on key advancements that aim to streamline quality measurement, improve interoperability, and accelerate the shift toward value-based care (VBC).

Healthcare IT Today caught up with Yurcisin at the 2024 NCQA Health Innovation Summit in Nashville, TN.

Key Takeaways

1. NCQA’s Digital Overhaul Simplifies Quality Measurement. By digitizing HEDIS measures into machine-readable formats like Clinical Quality Language (CQL), NCQA is cutting down interpretation errors and paving the way for standardized healthcare quality assessments.
2. FHIR Isn’t Complex. Yurcisin likens FHIR to high school-level computer science concepts. At its core, FHIR is simply a standard format for data and an interoperability framework. No different than JSON.
3. Bulk FHIR Data Exchange Gets a Performance Boost. NCQA’s Bulk FHIR Quality Coalition is working to improve the efficiency and accuracy of bulk data transfers, a critical step toward seamless interoperability and population health management.

Marching Towards Value-Based Care

NCQA oversees the Healthcare Effectiveness Data and Information Set (HEDIS), a widely used tool for measuring healthcare performance.

Yurcisin explained it with a fantastic analogy: “At NCQA we define health care quality for the country. We have measures that are utilized by the majority of healthcare. The country is moving from fee-for-service to value-based-care. The challenge is…what is value? Value is a function of both cost and quality…and NCQA defines quality, thus enabling value-based-care. You can think of us as Yelp. Somebody determines the dollar signs and someone else determines the star rating. NCQA is the star part.”

If the industry is going to move to VBC, it needs a standardized way to define and measure care quality. This puts NCQA in a unique position as a contributor on policy, process, and standardization for both data and quality in healthcare.

Digitizing Quality Measures for Precision and Scalability

NCQA’s work on digital quality measures (DQMs) is transforming healthcare data from static to dynamic. By converting the lengthy HEDIS Volume 2 measures into Clinical Quality Language (CQL), NCQA simplifies interpretation and eliminates ambiguity. This change empowers organizations to implement measures more consistently, leveraging existing FHIR-based interoperability standards.

“We have digitized the HEDIS measures in a language called CQL, which runs on top of FHIR data,” explained Yurcisin. “It’s a significant step toward reducing interpretation errors and standardizing quality measures across the industry.”

Tackling Data Quality at the Source

According to Yurcisin, “data quality is contextual.” NCQA is driving initiatives to ensure data used for HEDIS measures meets the highest standards, making it suitable for broader use cases like prior authorization and public health.

“If data is good enough to be used for HEDIS quality measurement, it’s good enough to be used for public health, prior authorization, and other CMS mandates,” said Yurcisin. “Clean data is the foundation for everything.”

What is the upside of all the work that NCQA is doing around data interoperability and quality? Yurcisin emphasized that AI is only as good as the data it consumes. By ensuring high-quality, interoperable datasets, NCQA is helping to lay the foundation for more advanced analytics and AI applications.

Learn more about NCQA at https://www.ncqa.org/

Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.

And for an exclusive look at our top stories, subscribe to our newsletter and YouTube.

Tell us what you think. Contact us here or on Twitter at @hcitoday. And if you’re interested in advertising with us, check out our various advertising packages and request our Media Kit.

In a recent interview, Ed Yurcisin, Chief Technology Officer of the National Committee for Quality Assurance (NCQA), shed light on key advancements that aim to streamline quality measurement, improve interoperability, and accelerate the shift toward value-based care (VBC).

Healthcare IT Today caught up with Yurcisin at the 2024 NCQA Health Innovation Summit in Nashville, TN.

Key Takeaways

1. NCQA’s Digital Overhaul Simplifies Quality Measurement. By digitizing HEDIS measures into machine-readable formats like Clinical Quality Language (CQL), NCQA is cutting down interpretation errors and paving the way for standardized healthcare quality assessments.
2. FHIR Isn’t Complex. Yurcisin likens FHIR to high school-level computer science concepts. At its core, FHIR is simply a standard format for data and an interoperability framework. No different than JSON.
3. Bulk FHIR Data Exchange Gets a Performance Boost. NCQA’s Bulk FHIR Quality Coalition is working to improve the efficiency and accuracy of bulk data transfers, a critical step toward seamless interoperability and population health management.

Marching Towards Value-Based Care

NCQA oversees the Healthcare Effectiveness Data and Information Set (HEDIS), a widely used tool for measuring healthcare performance.

Yurcisin explained it with a fantastic analogy: “At NCQA we define health care quality for the country. We have measures that are utilized by the majority of healthcare. The country is moving from fee-for-service to value-based-care. The challenge is…what is value? Value is a function of both cost and quality…and NCQA defines quality, thus enabling value-based-care. You can think of us as Yelp. Somebody determines the dollar signs and someone else determines the star rating. NCQA is the star part.”

If the industry is going to move to VBC, it needs a standardized way to define and measure care quality. This puts NCQA in a unique position as a contributor on policy, process, and standardization for both data and quality in healthcare.

Digitizing Quality Measures for Precision and Scalability

NCQA’s work on digital quality measures (DQMs) is transforming healthcare data from static to dynamic. By converting the lengthy HEDIS Volume 2 measures into Clinical Quality Language (CQL), NCQA simplifies interpretation and eliminates ambiguity. This change empowers organizations to implement measures more consistently, leveraging existing FHIR-based interoperability standards.

“We have digitized the HEDIS measures in a language called CQL, which runs on top of FHIR data,” explained Yurcisin. “It’s a significant step toward reducing interpretation errors and standardizing quality measures across the industry.”

Tackling Data Quality at the Source

According to Yurcisin, “data quality is contextual.” NCQA is driving initiatives to ensure data used for HEDIS measures meets the highest standards, making it suitable for broader use cases like prior authorization and public health.

“If data is good enough to be used for HEDIS quality measurement, it’s good enough to be used for public health, prior authorization, and other CMS mandates,” said Yurcisin. “Clean data is the foundation for everything.”

What is the upside of all the work that NCQA is doing around data interoperability and quality? Yurcisin emphasized that AI is only as good as the data it consumes. By ensuring high-quality, interoperable datasets, NCQA is helping to lay the foundation for more advanced analytics and AI applications.

Learn more about NCQA at https://www.ncqa.org/

Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.

And for an exclusive look at our top stories, subscribe to our newsletter and YouTube.

Tell us what you think. Contact us here or on Twitter at @hcitoday. And if you’re interested in advertising with us, check out our various advertising packages and request our Media Kit.