the ncqa baseline assessment tool
Download
Skip this Video
Download Presentation
The NCQA Baseline Assessment Tool

Loading in 2 Seconds...

play fullscreen
1 / 59

BATandMetadata - PowerPoint PPT Presentation


  • 431 Views
  • Uploaded on

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:

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'BATandMetadata' - libitha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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
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
the ncqa baseline assessment tool4
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.
sections of the bat
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
generating qarr measures
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
what is this metadata all about
What is this Metadata all About?
  • Metadata Categories
  • Basic Metadata Purposes
  • What Quality Management Does
  • Overview of Relevant Processes
  • Quality Approach to Information
metadata categories
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
basic metadata purposes
Basic Metadata Purposes:
  • Create common understanding
  • Foster process improvement
  • Enable information stewardship
metadata creates common understanding
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
metadata fosters information process improvement
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
information stewardship
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.

what quality management does
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
the definition of quality
The Definition of Quality

Meeting and exceeding stakeholder (customer) expectations and requirements

process improvement pdca shewhart cycle
Process Improvement:PDCA (Shewhart Cycle)
  • Planan improvement based on factual basis
  • Doit for awhile
  • Checkit for improvement
  • Actto standardize the improvement

(Repeat)

hedis qarr quality assessment and medical record review
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
lack of compliant instances by administrative data
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
hedis qarr quality assessment and medical record review25
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
hedis qarr quality assessment and medical record review27
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
hedis qarr quality assessment and medical record review29
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
hedis qarr quality assessment and medical record review30
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
quality approach to information
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
accuracy can t be automated
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
information quality measures
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
measure the product to improve its process
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
applications are not the product to measure
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
improving information the product is not the chief concern
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
three ways to correct information quality
Three Ways to Correct Information Quality
  • As a one-time process
  • As a regular conversion process
  • At the point of capture
as a one time process for a special table
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)
as a regular conversion for a data mart or data warehouse
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
at the point of capture
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
at the point of capture45
At the Point of Capture

Measure:

- Definitions

- Timeliness

- Completeness

- Accuracy

- Usability

Plan

Do

Check

Act

(Repeat)

do both
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)
process improvement for information
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)

process improvement steps
Process Improvement Steps
  • Plan:
    • Identify stakeholders/customers
    • Identify 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)

metadata categories52
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
production process factors
Production Process Factors
  • People
    • Stakeholders, Information Producers, Knowledge Workers
    • Developers, Analysts
  • Process
    • Business Information Production Processes
    • Application/Data Development Methods
  • Tools
    • Systems, Applications, Databases, Hardware
    • Metadata Repositories, Data Dictionaries, CASE Tools
  • Materials
    • Requirements, Specifications, Business Rules, Documented Procedures, Reports, Forms, External Data Sources
simplified picture
Simplified Picture

For each entity (Encounters, Members, Providers)

  • Who are its stakeholders?
  • What processes use it?
  • What are their requirements?
  • Then standards, measures, rules, definitions, specifications, etc.
slightly more detailed picture
Slightly More Detailed Picture
  • Definition Standards
  • Goals / Motivations
  • Product Specifications
  • Roles – Owners, Stakeholders
  • Business Requirements
  • Production Processes
  • Improvement Processes
  • Performance Measures
  • Performance Rates
purposes of metadata
Purposes of Metadata
  • Foster process improvement for information
  • Enable information producers to understand requirements from an enterprise standpoint, for both business and technical/development processes
  • See all stakeholders, their processes that depend on the information, and their requirements
  • Provide clear, accurate consensus definitions to enable problem resolution
  • Enable developers to standardize and reuse specifications and business rules
  • Manage information as a resource, including identifying needless cost, how much value you\'re deriving, how and where
useful steps to take
Useful Steps to Take
  • Work on information production processes by surveying stakeholders for their requirements
  • Measure business and development processes according to requirements for the information as voiced by stakeholders
  • Improve information production processes at the point of capture
  • Devise rules for cleanup and transfer to decision support systems (CRMS) in collaboration with stakeholders
  • Begin to store metadata: Document and share stakeholders, processes, requirements, performance measures, business rules, etc.
ad