Performance measurement lies at the heart of any quality improvement process. But how do we know if the data collected from these measures is credible? The first step is to select measures that are valid and reliable. The second step is to engage an independent third party to evaluate the data for accuracy and completeness. URAC’s measures program has entered its second phase, which requires an audit of the measures data submitted by clients on an annual basis.
The purpose of URAC’s data validation program is to identify areas of opportunity for improvement and to ensure ongoing compliance and conformity to program standards. By requiring organizations to submit audited performance measure data annually, URAC ensures accurate and reliable data for organization-to-organization comparisons, which is a goal of public reporting.
URAC has approved seven Data Validation Vendors (DVV) that have been selected based upon their expertise, their experience and their approach to validation.
These DVVs must adhere to URAC’s Validation Principles:
- The data validation process verifies that the organization’s measure production process conforms to the technical measure specifications;
- The data validation process evaluates the organization’s information system capabilities and its ability to process medical member and practitioner information and accurately report data;
- The results of a detailed source code review should be carefully selected to ensure applicability to all measures and that the programing is accurate and complies with measure specifications; and
- The data validation process should be collaborative and constructive to maximize the number of performance measures that can be reported to the public.
URAC-accredited organizations are required to have an initial on-site visit which usually takes one day but can be longer depending upon the size and structure of the organization and the number of additional locations that are relevant to measure reporting. The validation is conducted by a team consisting of at least one Certified Auditor. During the visit, the team conducts interviews, reviews systems, processes and measure-specific data collection and assesses the level of data completeness. The visit concludes with a closing session, where the initial findings are discussed.
After the on-site review and based on the DVV’s requests, clients may submit additional documents and/or implement corrective actions as required. At this point, final rates and results are compared to benchmarks, specifically the client’s prior year’s data and national means and percentiles. The validated measure calculations are designated as materially accurate, or materially inaccurate. Materially inaccurate rates should not be publicly reported. A report is generated by the DVV and is provided to the organization and to URAC.
The goal of measurement is to improve the quality of care provided to consumers. Such a system must have the ability to produce information that helps support consumer and other stakeholder decision-making. A key element to reporting on performance is to make certain that the data, which is self-reported, is accurate. To ensure credibility of the information, an external data validation function is required.