02 — Capability · BC-1850.10
Clinical Quality Measurement
Know how well the organization's care performs against required measures and its own goals, submit measures to regulators, payers and quality programs accurately and on time, and improve where results fall short. Inspecting and testing products is general quality management.
- Quality Reporting
- Quality Measures Program
- eCQM Reporting
In scope
- Measure abstraction, calculation and validation
- Submission to regulators, payers and quality programs, including HEDIS and star ratings for health plans
- Standardized patient and member experience surveys
- Quality benchmarking and improvement projects
Out of scope
- Product quality planning and inspection (see BC-550.20)
- Experience measurement outside required survey programs (see BC-460.20)
- Value-based contract performance and settlement (see BC-1860.30)
- Business intelligence platforms and reporting in general (see BC-750.50)
Realized by · 2
- Epic · Cosmospartial via BC-1850.10.40
- MEDITECH Expanse · Population Health and Care Compassstrong via BC-1850.10.40
Used in · 2
Build it · 0
- Nothing in the library points here yet.
Decomposes into · 6
- BC-1850.10.10Measure Data AbstractionGather the data each quality measure needs from the health record, claims and supplemental data, by chart review (including records requested from providers) or electronically, and validate it before results are calculated.
- BC-1850.10.20Quality Measure SubmissionCalculate measure results and submit them to regulators, payers and quality programs in the required format and by each deadline.
- BC-1850.10.30Patient Experience SurveysRun the standardized patient and member experience surveys that quality and payment programs require, and feed the results into quality scores.
- BC-1850.10.40Quality Results BenchmarkingCompare measure results with peers, targets and prior periods, and show leaders and clinical teams where performance falls short.
- BC-1850.10.50Care Quality ImprovementRun structured improvement projects on measures that fall short and on unwarranted variation in care, and confirm that the gains hold.
- BC-1850.10.60Star Ratings ImprovementTrack a health plan's or hospital's star ratings measure by measure, forecast where the cut points will fall, and run the cross-functional work that lifts them.