Maximize HCC v28 Recapture Rates: Effective Provider Incentive Strategies
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The countdown to mandatory eCQM (electronic clinical quality measure) reporting is on! With the 2026 CMS (Centers for Medicare &Medicaid Services) deadline looming, transitioning from CMS Web Interface to eCQMs, CQMS, or Medicare CQMs presents challenges and opportunities for Accountable Care Organizations (ACOs).
Because eCQM reporting requirements are complex and comprehensive, the shift from the CMS Web Interface requires ACOs to evaluate the reporting options and select a CMS Qualified Registry vendor.
ACO leaders know the significance of accurate quality reporting, so thoroughly evaluating potential vendors and their experience is critical. In order to achieve successful reporting, ACOs need to accurately capture clinical data from every EHR system in their network - aggregating and de-duplicating patients and data to create a single, new report for submission that complies with the evolving CMS quality reporting requirements.
Choosing a trusted CMS Qualified Registry vendor is essential to minimize financial and reputational risks with your provider network. Penalties for non-compliance can be severe, while inaccurate or incomplete reporting can jeopardize quality measures rankings and shared savings bonuses.
This article provides insights into minimizing the cost and risk associated with eCQM reporting requirements. It encourages ACOs to seek a comprehensive solution holistically addressing their value-based care analytic and reporting needs. By partnering with a single, trusted vendor with deep data aggregation expertise, ACO leaders and providers can be confident in their quality data and have peace of mind that their reporting will be accurate.
The road to eCQM implementation is fraught with complexity due to the comprehensive nature of the reporting requirements across your provider network. ACOs must manage data collection and aggregation across their entire provider network regardless of the EHR system; avoiding missteps will be critical to ensure quality reporting success.
Here are some challenges and ways to minimize your risks:
When it comes to eCQM reporting, relying on fragmented solutions can put your quality payments at risk. Most analytics platform vendors offer eCQM reporting through a third-party partnership, but this approach has significant drawbacks and risks.
Ensuring accurate clinical data capture and adherence to reporting requirements for eCQMs are crucial. Inaccurate and incomplete data can quickly derail your quality improvement efforts and jeopardize your shared savings bonus. Data accuracy and integrity are at higher risk when a vendor other than your core population health analytics vendor aggregates and prepares your quality reporting submission. A different vendor’s processes, aggregation methodologies, measure calculations, etc., can impact the accuracy of your data and reports. ACO leaders must be confident that their quality submission files reflect the actual performance of their ACO provider network.
Second, many Qualified Registry vendors can perform the quality reporting submission requirements but cannot meet the complexities of your population health analytics needs. This “duct tape” approach with different point solutions means you're juggling multiple vendors for eCQM reporting and value-based care analytics. Which vendor do you hold accountable for errors, omissions, or incomplete reporting performance?
Third and most concerning, you must manage and oversee the collection, aggregation, and reporting of data from your EHR systems, population health analytics solution, and eCQM reporting solution to ensure it is complete and accurate. If you find discrepancies, you will have delays and need to determine where the breakdown occurred—with multiple vendors, identifying who is accountable adds unnecessary complexity and risk to your performance payments. This finger-pointing and blame game can lead to frustrations and concerns within your provider network if quality bonuses are at risk.
ACOs that fail to accurately reflect their quality performance in the QRDA submission can face financial loss. ACO leaders must examine all angles when selecting a Qualified Registry vendor; understanding the risks, benefits, and experience of potential vendors is critical. Past performance and client satisfaction are good indicators of success with this new reporting requirement.
Inaccurate eCQM reporting poses a serious threat to ACOs and their network providers, with the potential for reputational damage that could have far-reaching consequences. A failure in eCQM quality reporting can erode trust with your providers and undermine the ACO administration’s credibility, which has been painstakingly built over time.
The stakes are high, and healthcare leaders must take proactive steps to ensure the integrity of their eCQM reporting and vendors. Robust data governance, streamlined workflows, and a commitment to transparency are all critical components of a comprehensive strategy to mitigate the risks of fragmented reporting and a failed submission.
When navigating the complexities of your MSSP value-based care program, an integrated eCQM solution is an invaluable asset.
By consolidating all the necessary functionalities into a comprehensive population health analytics platform, ACOs can streamline their population health management efforts and drive sustained success in MSSP programs throughout the year while reducing the risk and stress of submission failure.
At the heart of an integrated eCQM/Analytics solution lies the ability to accurately aggregate, normalize, manage, and optimize performance across a wide range of quality measures and value-based care initiatives. Moreover, seamlessly integrating workflow processes and analytical capabilities within a single platform eliminates the need to juggle multiple disparate vendors and their different systems. This enhances efficiency and fosters a deeper understanding of the interconnected factors influencing population health. By having all the necessary tools and insights at their fingertips, healthcare organizations can navigate the complexities of value-based care with confidence and agility.
By working with a single vendor to manage all your eCQM and population health analytics needs, you'll enjoy the benefits of a trustworthy single source of truth.
With a unified platform, your clinical and claims data lives in one place, eliminating the finger-pointing and lack of accountability that can occur when working with multiple vendors. This cohesive approach ensures seamless data management and reporting, giving you complete visibility and control over your quality metrics and value-based care performance.
A single vendor reduces the administrative overhead and vendor management burden that healthcare providers often face when working with disparate solutions. An integrated approach is also more cost-effective than the fees and expenses associated with engaging a standalone eCQM vendor.
Overall, the holistic, unified nature of integrated ECM solutions allows providers to enhance efficiency, cut costs, and avoid the legal and financial ramifications of quality measure noncompliance - all while maintaining a solid quality reputation in the eyes of patients, providers, and CMS.
When it comes to choosing the right analytics partner for eCQM reporting, there are several key factors to consider:
Choose a vendor with extensive experience in quality reporting programs and broader population health analytics. A partner with NCQA DAV (Data Aggregation Validation) certification has demonstrated competency in collecting and aggregating electronic clinical data from disparate systems to report on HEDIS® quality measures to the payer communities. This certification and achieving a CMS Qualified Registry status translate to an ability to confidently handle eCQM submissions and guide you in leveraging clinical data for better financial performance.
Exceptional client service is essential — look for a trusted partner who acts as an extension of your team and provides ongoing guidance and support to excel in value-based care. Talk with current clients to understand how satisfied they are with the vendor, their solutions, and how historically responsive they have been.
Qualified registries play a vital role by helping ACOs accurately and efficiently aggregate data from across their various clinical systems, creating a centralized and normalized view essential for robust analytics and reporting. Look for a vendor with a proven high client satisfaction track record for data aggregation expertise and transparency.
The transition to eCQMs is inevitable, and an experienced, Qualified Registry vendor is urgently needed. Select a single vendor for an integrated eCQM and value-based care solution to minimize complexity and costs. This platform should manage eCQM data capture, submission, and analysis while supporting value-based care programs such as quality reporting, risk stratification, and population health management. A unified solution from a trusted partner empowers your organization to succeed confidently in risk-based agreements.
Contact us to learn how our comprehensive eCQM and value-based care solution can help you succeed.
