Author: Jessica Hagins
The N.C. Health Information Exchange Authority is partnering with the Division of Health Benefits to leverage NC HealthConnex, the state-designated health information exchange, to improve data exchange in support of NC Medicaid’s quality, population health and care management efforts by improving data exchange.
The NC HIEA has worked closely with NC Medicaid since 2020 on projects ranging from Covid surveillance to the Medicaid Managed Care launch.
Recognizing the success of this work, NC Medicaid submitted a request to the Centers for Medicare & Medicaid Services (CMS) for enhanced federal financial participation to support three additional use cases of NC HealthConnex. The request was approved, kicking off a two-year design, development and implementation process that runs through Sept. 30, 2026.
The new use cases are as follows:
- Digital Quality Measures (dQMs) – Develop the capabilities to calculate a selected set of Medicaid’s high-priority quality measures combining both administrative data (claims and encounters) with clinical information from providers' EHRs to allow for more timely results.
- Health-Related Social Needs (HRSN) – Develop the capabilities to share Medicaid members’ responses to HRSN screening questions with other providers, Prepaid Health Plans (PHPs) and NC Medicaid to prevent unnecessary rescreening and facilitate referrals.
- Care Management (CM) Data Exchange – Improve the ability to exchange claims/encounter data and care management interaction details between PHPs and local care management entities to facilitate seamless transitions of care and support the provision of care management services.
The NC HIEA team has begun presenting preliminary information about participating in these use cases to audiences such as NC Medicaid Standard Plans and the Clinical Data User Group. We will also be sharing this information at an upcoming Advanced Medical Home Technical Advisory Group Data Subcommittee meeting.
We are seeking current participants of the NC HIEA who would like to become early adopters of the dQM and HRSN use cases. The following FAQs provide more information about participation.
Participation FAQs
Is participation in these use cases mandatory as part of compliance with the HIE Act?
No. At this time, participation in these use cases is not mandatory; however, these efforts will not work without early adopters to lead the way.
What is the benefit of becoming an early adopter?
There is a payment incentive for participating that is still being determined. The NC HIEA is developing a provider support program to welcome early adopters of the dQM and HRSN use cases that will provide time-limited, direct payments to provider organizations upon completion of agreed upon technical and workflow milestones for each use case. Early adopter incentives are still in preliminary planning stages.
How is participation in these use cases different from the mandate to connect?
All of the data elements related to dQMs are already being sent by providers mandated to connect to NC HealthConnex by the HIE Act. However, providers who wish to join the dQM use case must also undergo certification in the National Committee for Quality Assurance (NCQA) Data Aggregator Validation program and participate in quality improvement initiatives for three priority quality measures which may necessitate technical upgrades and/or strategic workflow changes.
Joining the HRSN use case requires sending in separate data elements in addition to those required by the connection mandate. Provider organizations participating in the HRSN use case will be asked to map their HRSN screening questions and patients’ responses to the applicable codes defined in the Logical Observation Identifiers Names and Codes (LOINC) standards and transmit that information to NC HealthConnex. Materials are being created that will explain these optional connections.
How can I learn more?
We are developing materials that will explain each of these use cases in more detail. We will continue to share this information as it becomes available. Please subscribe to the NC HIEA newsletter and check our website to follow updates on this initiative.
How do I get involved?
If your organization is interested in being an early participant in our efforts to support dQMs or collect standardized HRSN data, reach out to our business development team at hiea@nc.gov.