HSX is among the first health information exchanges (HIEs) in the U.S. to achieve Data Aggregator Validation (DAV) certification from the National Committee for Quality Assurance (NCQA), the independent organization that accredits and certifies healthcare organizations for activities supporting the Healthcare Effectiveness Data and Information Set (HEDIS®) quality measurement program.
Healthcare quality measurement is increasingly becoming digital. The proliferation of quality measures and the extensive manual efforts that go into collecting and validating data used to calculate them has created an expensive administrative burden that can be significantly reduced by using clinical and administrative data from electronic health records (EHRs). Organizations like HSX that aggregate data from many healthcare providers can serve as a single source for data used in quality measurement.
How Do HSX Members Benefit?
Health plans that use HSX’s DAV-certified data stream may use the data as Standard Supplemental Data for HEDIS purposes, meaning that the data are not subject to audit at the health plan level during HEDIS season because the data have already undergone Primary Source Verification (PSV). For each site whose data are deemed compliant in PSV, payers may rely on HSX as the source of truth and do not need to gather further evidence in chart chases with the providers.
Payers also benefit by ingesting Consolidated Continuity of Care Documents (C-CCDs) from HSX directly into their HEDIS engines. As part of the DAV certification, NCQA has vetted HSX’s DAV feed as conforming to the NCQA C-CCD Implementation Guide, so payers can have one standardized feed to ingest rather than the numerous variations inherent in connecting to individual providers directly.
Healthcare providers benefit by getting credit for more of the care they provide when payers calculate provider-specific quality measures as part of value-based contracts. Providers save time and effort associated with creating and maintaining individual interfaces with every payer, as well as the annual burden of chart chases during HEDIS season. HSX also works with providers to optimize their data for quality measurement, identifying opportunities to improve the quality of their data feeds.
Third-party partners of health plans and providers who want to make their data more valuable can share data through HSX and request that it be included in the next DAV cycle. If an organization generating clinical data for a payer sends their data directly to the payer, it can only be considered non-standard supplemental data for HEDIS purposes, meaning the payer still must obtain original source documents to include it. Sharing the same data through HSX removes that obstacle.
View the list of HealthShare Exchange DAV-Certified Sites for HEDIS measurement year (MY) 2023.
What Does the DAV Certification Involve?
As part of the annual certification process, HSX underwent a rigorous audit similar to the audits health plans undergo for HEDIS. The three parts of the certification are:
- Review of policies, procedures and systems for data aggregation as well as evidence that HSX follows those controls.
- Testing the HSX C-CCD .xml output format to verify conformance with NCQAs Implementation Guide.
- Primary Source Verification, in which sample cases are selected to compare the data held by HSX with data from the same encounter as it exists in the legal medical record.
Health plans that want to use DAV-certified data in their HEDIS workflow may need to establish a new connection to HSX, as the DAV data stream can only contain data from clinical sites that pass the PSV process.
To minimize costs, payers should also submit a panel focused on patients for whom HEDIS data are most important. The DAV stream will include one C-CCD for each patient on your DAV panel (assuming they had at least one encounter/observation) that aggregates all available data from approved clinical sites. Please work with HSX to determine your readiness to start receiving DAV-certified data.
For more information
To learn more about HSX’s DAV certification and how it can benefit your organization, please contact HSX Member Services at firstname.lastname@example.org.