NCQA provides a nationally recognized standard for validating an organization’s ability to collect, aggregate, and standardize healthcare data for quality measurement and reporting, such as Healthcare Effectiveness Data and Information Set (HEDIS). It represents more than 72% of the U.S. population.
Data Aggregator Validation enables HIEs to save payers significant amounts of time and effort conducting their own primary source verification of patient data. For HIEs, achieving this validation can open doors to partnerships with health plans, providers, and other stakeholders who require data quality assurance. The process involves a rigorous assessment of an HIE’s data management practices, technical infrastructure, and compliance with NCQA standards.
Major Factors to Consider
Data Quality and Integrity
Data quality is paramount in NCQA Data Aggregator Validation. HIEs must ensure that the data they collect and exchange is accurate, complete, and consistent. Doing so includes implementing robust data validation processes, addressing data gaps, and resolving inconsistencies. Key considerations include:
- Data Standardization: Ensuring data is standardized using industry standards such as HL7 and FHIR.
- Data Validation: Implementing automated and manual processes to validate data accuracy and completeness.
- Data Governance: Establishing clear data governance policies and procedures to maintain data integrity.
Technical Infrastructure
A robust technical infrastructure is essential for successful NCQA Data Aggregator Validation. HIEs must have systems in place to securely collect, store, and exchange healthcare data, including:
- Secure Data Storage: Implementing secure data storage solutions that comply with HIPAA and other regulations.
- Data Exchange Capabilities: Ensuring interoperability with various healthcare systems and the ability to exchange data securely.
- Data Processing and Aggregation: Having the capacity to process and aggregate large volumes of data efficiently.
Compliance and Security
Compliance with regulatory requirements is a critical aspect of NCQA Data Aggregator Validation. HIEs must adhere to HIPAA, state regulations, and NCQA standards. Key considerations include:
- Privacy and Security Policies: Developing and implementing comprehensive privacy and security policies.
- Access Controls: Implementing strict access controls to protect sensitive data.
- Audit Trails: Maintaining detailed audit trails of data access and modifications.
Documentation and Reporting
Thorough documentation is essential throughout the NCQA Data Aggregator Validation process. HIEs must maintain detailed records of their data management practices, technical infrastructure, and compliance activities. This includes:
- Policy and Procedure Documentation: Documenting all data management policies and procedures.
- Technical Documentation: Maintaining detailed documentation of technical systems and processes.
- Reporting Capabilities: Ensuring the ability to generate accurate and timely reports for NCQA audits.
In all these ways, NCQA creates the gold standard for ensuring data is clean, usable, and secure.
Planning on joining the next NCQA data aggregation validation cohort? J2 has been helping HIEs navigate NCQA’s validation program for years. For best practices on how to successfully navigate an NQCA data aggregation validation cohort, check out our guide for HIEs here.
You can also reach out for a free strategy session to ensure you’re on the right track for the successful completion of NCQA’s program.
