NCQA Urges Expedited Adoption of Digital Quality Measures

A set of policy recommendations from the National Committee for Quality Assurance (NCQA) stresses the importance of building a strong digital health infrastructure that facilitates seamless exchange, promotes adoption of digital quality measures and maximizes the full potential of interoperable healthcare data via FHIR API implementations. 

NCQA is a nonprofit, independent organization that works to improve healthcare quality through measurement, transparency and accountability.

Digital quality measures
NCQA said it supported the first Trump administration’s commitment to transition all CMS quality reporting and value-based care programs to FHIR-based digital quality measures (dQM) by 2025. However, it noted that this goal was deprioritized, slowing FHIR adoption in American healthcare. A recent ASTP/ONC survey found that only a fifth of healthcare organizations routinely make data available through HL7 FHIR APIs. NCQA suggests that HHS create a clearer framework for a national digital health data ecosystem, within which all participants in healthcare can innovate and benefit, building on existing mandates for FHIR APIs, USCDI and industry innovation in patient-generated data.

To enhance the quality measure reporting process, NCQA urges HHS to expedite adoption of a dQM reporting architecture. “Continued investment in non-FHIR based quality measures could impede progress toward utilizing aggregated clinical and non-clinical data, and slow healthcare innovation,” the report states. “HHS should prioritize dQMs, which are designed to adapt to different accountability structures, including providers, ACOs and health plans. This shift will facilitate more accurate, comprehensive and flexible reporting across diverse health care organizations.”

The organization also recommends that HHS accelerate alignment with the CMS Universal Foundation across HHS quality reporting and value-based payment programs, and also that ASTP and other federal agencies clarify how the USCDI+ Quality dataset will interact with regulations. “Establishing a clear pathway for integrating USCDI+ datasets into regulatory frameworks will be vital to achieving true interoperability of quality data,” the report said.

NCQAS suggested other immediate steps CMS could take to encourage data sharing across the system, including introducing one or more Medicare Advantage Star Ratings metrics that promote standardized data exchange between Medicare Advantage plans, their provider networks and patients.

NCQA also recommends that HHS prioritize more effective use of patient-generated data, including person-reported outcome measures (PROMs).

Behavioral health recommendations

NCQA urges the Trump administration to collaborate with Congress to appropriate funds to incentivize behavioral health provider adoption of certified EHRs, with appropriate safeguards for patient privacy and measures to prevent fraud, waste and abuse.

It said the Trump administration should instruct HHS to fund creation of a quality measures cascade framework for substance use disorder care, ensuring the establishment of quality standards at every appropriate level of care. Such a framework would guide patients to high-quality care while facilitating the transition to value-based care among providers, NCAW said.

Proposed changes for CMMI

While NCQA said it strongly supports the mission of the Centers for Medicare & Medicaid Innovation (CMMI), it notes that only a few CMMI initiatives have actually advanced quality or delivered substantial savings for American taxpayers. It encourages CMMI’s new leadership to break from existing limitations and create models that prioritize integration through technology and dynamic care plans. 

NCQA stressed that CMMI’s models should: 
• Focus on conditions and procedures with significant cost variability, large patient volumes and clear opportunities to reduce complications, hospital readmissions and unnecessary utilization.

• Require collaboration in co-developing AI-driven models targeting 6–8 clinical problem areas (e.g., diabetes, congestive heart failure) and 8–10 procedures (e.g., hip replacement, CABG).

• Take steps to promote widespread industry adoption of FHIR data exchange standards, such as incentives for digital health data exchange that can empower better decisions by placing needed information in the hands of patients and practitioners.

• Adopt AI-powered, evidence-based shared care plans to build trust and empower patient choice. Plans should reflect patient-driven goals and be accessible to the entire care team. By utilizing generative AI and deterministic rules, interventions can be personalized with patient-facing digital tools that enhance the overall experience.