From fragmented data to meaningful action: Building a stronger foundation for quality

Start with a strong data foundation

UMass Memorial Health manages a complex quality reporting environment that spans multiple EHRs and value-based care programs. 

To create a more consistent foundation for measurement, the organization works with Optum to normalize claims data for HEDIS® measurement across payers and supplements that foundation with payer quality reports, EHR data and information from affiliate partners. 

As Laura Burns, Senior Data Scientist at UMass Memorial Health, explains, “The thing that makes our partnership with Optum so valuable is it gives us a normalized source of truth for HEDIS measurement across payers.” 

Establishing that foundation can help organizations move beyond reporting alone. UMass Memorial Health uses its data to examine trends, identify opportunities for improvement and provide information that can support clinical action.

Build confidence in data earlier

The transition to digital quality makes the reliability of underlying data increasingly important. 

NCQA is working toward moving confidence and validation upstream, closer to the source of the data. Its approach considers factors such as usability, plausibility, stability and integrity to assess whether data is reliable and fit for use. 

The goal is to move away from relying primarily on manual, retrospective verification toward an approach that is more continuous and scalable.  

Marlene McIntyre, Assistant Vice President for Digital Solutions at NCQA, advises that the industry will need to rethink traditional approaches to data validation as digital quality advances: “We [leaders in the quality industry] cannot manually verify our way to digital quality or we just won’t be successful.”  

Beginning with measurement year 2027, NCQA plans to start transitioning away from primary source verification (PSV) as a universal requirement for HEDIS health plan reporting when appropriate data quality programs and validation are in place. 

Validation itself isn’t going away. Instead, the approach is intended to make it more targeted and risk-based.  

For Optum, one of the key actions is straightforward. “Validate before you report,” says Shariff Baseer, who leads product for Quality Optimization at Optum.

Turn trusted data into action

A strong data foundation becomes more valuable when it helps reveal where action may be needed. 

UMass Memorial Health saw that connection when its reporting identified an opportunity to improve colorectal cancer screening among a newly eligible younger population. 

The organization introduced an intervention that included bulk Epic orders for Cologuard tests. By the end of 2025, performance among this population was almost 10% higher than at the end of the previous year. 

The example illustrates the broader opportunity: Use trusted data to identify areas for improvement, inform targeted interventions and monitor performance over time. 

Having trusted data is only part of the equation. Organizations also need to make that information useful to the people responsible for improving performance. 

Tracey Wilkie, AVP of Population Health and Value-Based Care Analytics at UMass Memorial Health, adds, “There is something in the data for each role in the organization, whether it’s the CFO or it’s a practice champion in one of our clinics. All of the reporting has to be segmented to its appropriate audience.” 

A platform-based approach can help bring these activities together. Quality Optimization, a module within the Optum Value Connect platform, can help unify the reporting infrastructure to support operational improvement and performance measurement across payers and providers.

The time to start is now

Organizations don’t need to transform their quality infrastructure all at once. But they can begin by understanding the strength of the foundation they have today. 

NCQA recommends that organizations do not delay the start of their data quality journey. An early assessment of current data quality practices and potential gaps can provide a foundation for determining the next steps.  

That means asking fundamental questions: Is the starting data reliable? Are quality issues being identified early enough? Does reporting provide stakeholders with information they can use? 

As digital quality advances, organizations can prepare by focusing on three things: solid data, purposeful integration and meaningful action. And the time to start building that foundation is now.