Digital Quality at the NCQA Health Innovation Summit 2024

I just got back from my first-time NCQA Health Innovation Summit (HIS) in Nashville, TN. Three days of healthcare quality, dozens of sessions around four themes: Value-based Healthcare, Equity, Behavioral Health and, the reason we were there, Digital Quality.

The event kicked off by the renowned NCQA President Peggy O’Kane, who in 34 years built NCQA from the ground up and has healthcare quality in her blood like no one else. In her opening words, she presented her audience with the facts sharing a simple graph of healthcare spending versus healthcare performance in 10 countries, similar in welfare and GDP: the US all the way to the lower right (high spending, low performance) – the Netherlands high up and more to the left (lower spending, relative high performance).

Her first guest was the no-less renowned, former CEO of Kaiser Permanente and healthcare pundit, Robert Pearl, MD talking about the benefits of AI. This turned out to be a hymn to AI and how AI can help solve incessant problems like chronic diseases, health inequality, care for remote areas, etc.

Coincidentally, on Wednesday, Oracle founder Larry Ellison, also in Nashville for the Oracle Health Summit, was similarly advocating for AI to be utilized to help cure cancer, among other things. He proposed tackling these gigantic problems by going back to the principle question: “Where does the problem begin and where does it end?” Ellison coined this “Musk’s Law”.

As a tech entrepreneur and a European, I am awed and skeptical at the same time about this tech-will-solve-everything approach. Technology can do a lot but it won’t solve systemic problems, like healthcare inequality (as someone from the audience at the HIS seemed to imply when asking Dr. Pearl about her patients not even having access to technology). It’s similar to what we’ve learned with FHIR: amazing technology indeed, but interoperability requires so much more than “just” modern APIs.

We ran a poll in our booth asking visitors to give their opinion on where we’ll be in 3 years’ time with regards to digital quality measures. Most put their sticker in the section “Everything will remain the same.” Not a lot of faith in AI…

Many sessions at the summit discussed Digital Quality, and how digitization of the quality reporting process will not only take away the administrative burden but can also make quality reporting more useful for clinical practice by shortening the feedback loop between reporting and applying changes as part of the PDCA cycle (Plan-Do-Check-Act). Digital Quality means two things: going from paper to digital, and going from digital to digital based on open standards. In this case: FHIR and CQL (Clinical Quality Language). The latter is where we all want to go. This became clear on the main stage by comments from not only NCQA’s leadership but also from Michelle Schreiber from CMS.

Don Rucker, nowadays the Chief Strategy Officer at 1upHealth (who we all know and praise for the utterly elegant piece of legislation that is the National Coordinator of Health IT: the 21st Century Cures Act) demonstrated how CQL quality measures can be executed on a FHIR data repository within an NCQA Docker container. Rob Reynolds from Smile Digital Health brought the same point home. Quality Measurement shouldn’t be just looking in the rear mirror. You want to be able to intervene based on data before things go wrong. Firely’s Mat Osmanski demo’ed the latest CQL capabilities in Firely Server with HEDIS, CMS and custom measures.

If backed by CMS and NCQA, and if the standards and technology are there what can go wrong? Well, on the ground a lot has to happen. Health data is messy and the process of making sense of data is burdensome. This is especially the case for the payers. Marc DeJesus from Centene told us that he had to deal with 950 data streams for quality, counting a single EHR vendor with 2000 clinics as 1. Different sources, different versions, different sending dates… Standards will only do so much to make sense of this quagmire.

But there is hope. On Thursday, Ryan Howells and Ed Yurcisin presided over a panel of members of the Digital Quality Implementer Community, an NCQA initiative with the aim of creating a level playing field for CQL implementors. If you as a quality professional run a HEDIS measure you want the outcome to be the same regardless of your FHIR server. In the panel, along with myself, the trailblazers Rosh Singh (Cozeva), Irene Joseph (Microsoft), Bill Lakenan (Bellese), Amol Vyas (NCQA), Rob Reynolds (Smile Digital Health).

Final note: quite a few questions from the audience in various Digital Quality Sessions were related to education. Teach me FHIR + CQL + HEDIS. No worries. At Firley we already have FHIR training and CQL will soon be added and we’re exploring a combination of all three. It’s the future, after all!