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The NCQA Baseline Assessment Tool

The NCQA Baseline Assessment Tool . . . and How Sharing Information Production Process Metadata Fosters Process Improvement The BAT and Information Production Process Metadata What is the Baseline Assessment Tool? What is this Metadata all about? How it relates to:

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The NCQA Baseline Assessment Tool

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  1. The NCQA Baseline Assessment Tool . . . and How Sharing Information Production Process Metadata Fosters Process Improvement

  2. The BAT and Information Production Process Metadata • What is the Baseline Assessment Tool? • What is this Metadata all about? How it relates to: • Quality Management and Process Improvement • Information Production Processes • HEDIS/QARR • Process Improvement Details Useful for the BAT

  3. What is the BAT?

  4. The NCQA Baseline Assessment Tool • The BAT collects information that helps the NCQA assure that health plan information systems can generate reliable quality measures for HEDIS/QARR • Supports the NCQA's HEDIS Compliance Audit, an audit for compliance with HEDIS specifications for measures.

  5. Sections of the BAT • Data Processing Systems: • Encounters • Members • Providers • Completeness of Data • Integration of Data for Reporting • Controlling Integrity of Reporting • Medical Record Review • Other / General Information

  6. Quality Assurance Reporting Requirements (QARR)

  7. Generating QARR Measures • Extract random samples of member populations relevant to each measure • Calculate rates of those showing compliance with requirements for each measure • Includes visiting primary care sites, physically reviewing medical records, recording compliant instances

  8. What is this Metadata all About? • Metadata Categories • Basic Metadata Purposes • What Quality Management Does • Overview of Relevant Processes • Quality Approach to Information

  9. Metadata Categories • Production Process Factors • People • Process • Tools • Materials • Quality Measures • Timeliness • Completeness • Accuracy • Barriers to Quality (Root Causes) • Improvement Processes • Quality Assessment • Cleanup and Transfer • Process Improvement

  10. Basic Metadata Purposes: • Create common understanding • Foster process improvement • Enable information stewardship

  11. Metadata CreatesCommon Understanding Between: • Information Producers: • Business Process: data acquisition, entry and updating • Technical Process: developers and analysts • Information Stakeholders: • Anybody who uses the information for business

  12. Metadata FostersInformation Process Improvement • Establishes common understanding, from an enterprise standpoint, of all stakeholder requirements for information • Fosters collaboration, empowerment, teamwork, professionalism, pride of workmanship • Makes environment of information stewardship possible

  13. Information Stewardship Willingness to be accountable for a set of business information for the well-being of the larger organization, by operating in service of (rather than under control of) those around us.

  14. What Quality Management Does: • Brings producers and stakeholders together • Makes sure stakeholder requirements are fully represented • Assures completeness and objectivity of measures so they are reliable basis for understanding and managing functionality and performance • Establishes factual basis • Makes process improvement possible • Makes cross-functional teamwork possible • Makes performance management possible • Makes resource management possible

  15. The Definition of Quality Meeting and exceeding stakeholder (customer) expectations and requirements

  16. Process Improvement:PDCA (Shewhart Cycle) • Planan improvement based on factual basis • Doit for awhile • Checkit for improvement • Actto standardize the improvement (Repeat)

  17. Process Improvement:Root Cause Analysis

  18. Overview of Production Processes

  19. Encounters Information Producers

  20. Members Information Producers

  21. Providers Information Producers

  22. Encounters Stakeholders

  23. HEDIS/QARR Quality Assessment and Medical Record Review • Build CRMS • Create population samples • Extract compliant instances based on administrative data, along with member and provider site information, to a special QARR database • Load laptops from this database

  24. Lack of Compliant Instancesby Administrative Data • Compliance with measure conditions requires the following data elements to be present and accurate: • Recipient information • Service and diagnosis codes • Service location information • Provider information • Missing or inaccurate information necessitates the conduct of onsite medical record review

  25. HEDIS/QARR Quality Assessment and Medical Record Review • Review claims histories for all members in samples to identify most likely primary care provider • Sort samples and fax lists to each site, requesting charts for onsite review

  26. HEDIS/QARR Quality Assessment and Medical Record Review • Visit sites and review charts

  27. HEDIS/QARR Quality Assessment and Medical Record Review Track down charts not found at sites: • Verify Member name, CIN, SSN • Review claims history for other providers and spans of care • Check Healthy Beginnings / Mammogram Incentives databases • Check online Immunizations Registry • Check Phone logs • Check NY State Roster • Check http://www.whitepages.com • Call Providers • Call Members

  28. HEDIS/QARR Quality Assessment and Medical Record Review • Visit new locations and review again

  29. HEDIS/QARR Quality Assessment and Medical Record Review • Integrate and upload laptop data to CRMS • Use CRMS to generate rates • Send results to NY State Department of Health

  30. HEDIS/QARR Quality Assessment and Medical Record Review • Massive costs due to nonquality data • Nurses to sites throughout network, three times • Hunting down members, what provider they're getting care from, missing or miscoded services and diagnoses • 4300+ members in samples

  31. Foster common understanding between producers and stakeholders by use of shared metadata Accuracy can’t be automated; only people can assess and correct for accuracy Information is an enterprise resource Measure information quality in voice of downstream customers/stakeholders To improve a production process, measure its product Improve information quality at the point of capture Quality Approachto Information

  32. Foster Common Understanding Between Producers and Stakeholders

  33. Accuracy Can’t be Automated • Only people can create, assess, or correct for accurate information • Automatic business rules can only prevent gross errors • Checking against a surrogate source: comparison to external datasets, forms • Checking against authoritativesource: comparison to real world entity

  34. Measure Information Qualityin Voice of Stakeholders

  35. Information Quality Measures • Definitions/Specifications • Timeliness • Time from first capture to record of reference • Completeness • Represent each instance in the real world • Completeness of values in existing fields • Accuracy • To surrogate source • To authoritative source • Usability • Presence of fields to address functional requirements

  36. Measure the Productto Improve its Process • Purpose is not to improve a product by measuring it, but to improve its production process • Product is of concern only from a limited perspective • Quality measures show how well processes for producing information are functioning; i.e., how well they address all stakeholder requirements

  37. Applications are notthe Product to Measure • Assessing applications addresses narrow requirements, not downstream requirements for the information • Address information as the product, understood as an enterprise resource • Measure the information that applications work on to assess development • Applications are machines on the assembly line, not the product

  38. Applications are Machineson the Assembly Line

  39. Improving Information (the Product) is not the Chief Concern • Right product to measure, but wrong purpose • Improving the product doesn't prevent errors or assure ongoing quality • Improve production processes • Information product improvement is all cost basis/scrap and rework • Correction of issues preventable by process

  40. Three Ways to Correct Information Quality • As a one-time process • As a regular conversion process • At the point of capture

  41. As a One-time Process for a Special Table • Not preventative; same problems recur because information production process has not changed • Quality of data decays; not addressing changes in the information • Creates a redundant table for the entity (encounters, services, providers, members)

  42. As a Regular Conversion for a Data Mart or Data Warehouse • Performed under constraint of a regular load for up-to-the-moment, daily analysis • Too late: requires automatic, estimated corrections • Corrections need to feed back to operational tables

  43. As a Regular Conversion for a Data Mart or Data Warehouse

  44. At the Point of Capture • Actual process improvement • Actually preventative • Based on understanding of information as enterprise resource • Information producers assess and improve business and technical/development processes based on understanding of stakeholder requirements

  45. At the Point of Capture Measure: - Definitions - Timeliness - Completeness - Accuracy - Usability Plan Do Check Act (Repeat)

  46. Do Both: • Improve at Point of Capture:Measure and improve information production process quality at the point of capture, from the standpoint of the requirements of all downstream stakeholders • Regular Cleanup and Transfer: Establish and document business rules for integration (cleanup and transfer), through stakeholder involvement (i.e., for CRMS load)

  47. Process Improvement for Information • Plan: • Identify stakeholders/customers • Survey stakeholders for requirements • Measure quality of product against requirements • Determine root cause for identified issues • Do: • Implement improvement for awhile • Check: • Measure again to determine success of improvement • Act: • Act to standardize the improvement (Repeat)

  48. Root Cause Analysis for Information

  49. Root Cause Analysis for Information

  50. Process Improvement Details Useful for the NCQA Baseline Assessment Tool

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