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Industry Insights: Mandi Wasik on Data Aggregation and Quality

The demand for robust, accurate, and actionable healthcare data has never been more critical. Healthcare organizations – both providers and payers – are looking for ways to be more efficient and patient-centric to reduce costs and improve outcomes. The Health Information Exchange (HIE) industry plays a critical role in making clinical data available across the healthcare ecosystem. And HIEs are also in the forefront of recognizing the challenges associated with making clinical data truly useful.

I have worked with HIEs for over a decade. I’ve seen firsthand the myriad quality challenges that are associated with multi-source and multi-format data. I’ve experienced the challenges of aggregating data from providers, ranging from solo practitioners to large hospital systems, into a standards-based longitudinal record that is of high quality and consistent with clinical intent.  

In 2020, I was working with a HIE and had the opportunity to participate in the beta phase for the National Committee for Quality Assurance (NCQA) Data Aggregator Validation (DAV) program. The NCQA DAV program was established to meticulously evaluate clinical data streams to ensure the accuracy and dependability of aggregated data used by health plans, providers, and government organizations.

Auditors from NCQA launched what I expected to be a routine audit. However, it quickly became apparent that this was far from routine and would turn out to be a transformative experience. The rigorous validation process, which spans 18-20 weeks, presented challenges, such as resource-intensive data analysis, rigorous documentation requirements, and meticulous scrutiny of internal protocols and procedures. Despite these hurdles, the audit process proved instrumental in identifying areas for improvement of data quality within the HIE organization. 

Fast forward, I have now been engaged as a program manager in the DAV process on a continual basis, most recently as part of Availity’s clinical solutions business unit. Availity is a Certified Data Partner, supporting HIEs in achieving and maintaining program requirements. For instance, Availity partners with KONZA National Network, which was also an early adopter of the DAV program. Participating in the very first DAV cohort allowed each organization to provide feedback on the DAV program requirements and improve our processes to ensure streamlined data exchange between stakeholders. Currently, KONZA is one of the largest and most reputable organizations delivering Certified Data Streams. KONZA maintains 348 DAV-accredited organizations and validates three times the number of cases as the average participant in the program.

From a financial perspective, the DAV program is extremely valuable for both HIEs and health plans. Many HIEs initially started on a small scale, but as time passed, these entities began to consolidate. Some HIEs merged or absorbed smaller ones to remain viable, a trend that continues in the industry. As a result, HIEs are actively seeking ways to generate revenue. Participating in initiatives like the DAV program presents an opportunity to help secure financial stability and ensure long-term sustainability. 

As for health plans, they currently invest significant resources in primary source verification (PSV), which are rigorous audits to ensure that data used for reporting is consistent with information received from provider electronic health records (EHRs). By using data that has been validated under the DAV program, health plans can save time and effort, eliminating the need for expensive chart chasing and PSV. 

This streamlined approach simplifies processes and ensures reliable, accurate data for quality measurement programs like HEDIS®. As NCQA and the Centers for Medicare & Medicaid Services (CMS) move into digital quality measures, it’s becoming increasingly important to have a strategy to acquire and deploy high quality clinical data for quality measurement. Using DAV data from HIEs is an important step in establishing a digital quality measurement strategy.

I applaud the NCQA for supporting the integrity of aggregated clinical data for quality reporting, value-based contracting, and closing gaps in care. It’s also gratifying to note that NCQA has made recent changes to the DAV program to reduce some of the administrative burden and resource costs for participants. I hope this will encourage more HIEs to consider taking their providers through the program. 

As a proud Certified Data Partner, Availity provides technology and program support for successful validation. For example, Availity Fusion™, an API-based technology to aggregate multi-source clinical data, automatically generates an NCQA-compliant continuity of care document (CCD), which is required for successful validation. 

Availity’s participation in the program has led to sharing innovative data quality improvement approaches with NCQA and auditors – all while ensuring the success of HIE partners. Availity stands out by transforming data to align with necessary code sets and interoperability requirements, a process we term Upcycling Data™. Upcycling Data involves a comprehensive data quality enhancement process that normalizes and enriches data while preserving clinical intent and data provenance. 

Choosing Availity as a Certified Data partner helps ensure validation requirements are met at lower risk and with fewer resources. If you’re interested in learning more about how we can help you achieve DAV program success, please contact Amy Krane at [email protected].  

Author Bio   

With a journey in the HIE space that began in 2010, Mandi gained hands-on experience serving in many roles, from patient management to leading interface teams. Having been part of the pioneering NCQA DAV program at her previous HIE, Mandi extends her expertise to Availity Fusion clients through the DAV program. 

As Program Manager of Data Connectivity at Availity, Mandi leverages her extensive knowledge of clinical data and interface experience to define the specific data requirements sought by payers. Additionally, she plays a vital role in identifying the optimal sources to procure this data, while streamlining processes for our partners to access clinical data with greater ease and efficiency.