NCQA Measurement and Remeasurement Analysis Clarified

By Nancy Ross Bell, RN

Estimated time to read: 3 minutes

NCQA utilizes a consistent performance assessment method across all standards. Its two-part method ensures that organizations not only track performance numerically by quantitative analysis but also comprehend the underlying reasons when needed through qualitative analysis.

However, confusion can occur when the same measures are analyzed year after year and crossover from one Renewal survey to a second Renewal survey.  This blog clarifies how measures apply to each survey and look-back period.

What are Initial Measures vs Remeasures?  

Initial measurement is the first measurement of a measure.  Every subsequent measurement of the same measure is a remeasurement. 

If an initial measure is implemented in the year prior to the 2-year look-back period beginning, and then the subsequent measures after the initial one, that occur during the 24 months of the look-back period, are considered remeasurement. 

Special scenarios can occur, such as when a measure has been in place for more than three years and is considered a remeasurement for all three years of the current renewal cycle. 

What Analyses Are Required?

Following the initial measure, a qualitative and quantitative analysis is required.  When all goals are met, assess the drivers of the positive results.

For each remeasurement, a quantitative analysis is conducted, comparing results to the goal. A qualitative analysis is only required if the goal is not met.  If the goal was not met, then actions to improve are planned and implemented. 

Qualitative analysis explores the reasons for the results. The drivers of results may include, but are not limited to, systems, processes, staff, and equipment.

• Initial Measurement: Requires both quantitative and qualitative analysis.
• Remeasurement: Requires quantitative analysis, and qualitative analysis only if goals are not met.

A sound qualitative analysis, when done right, drives to the root of the problem and prompts stakeholders to design targeted action plans to help ensure measurable improvement. Read MHR’s March 8, 2024, blog on qualitative analysis, where we list Key Points.   

Can the Same Measure Be Continued From One Renewal Survey to the Next Renewal Survey?

The answer is yes.* When carrying over the same measure from one survey cycle to another survey cycle, the initial measurement is still the first measurement of the measure, only the first time the measure is introduced.  Two remeasurements during the look-back period and quantitative analyses are required. However, qualitative analyses are required only if goals are not met.

*While the same measures may be used, new goals for continual improvement should be established as appropriate.

Here is the scenario:

FIRST RENEWAL SURVEY

Year 1: The Initial measurement is an introduction of a new measure in year one and is prior to the look-back period. Conduct both a quantitative and qualitative analysis. This is data point 1.

Year 2: Remeasurement #1 is conducted during the first 12-month period of the 24-month look-back period. Quantitative analysis is required. Qualitative analysis is required if goals are not met. This is data point 2.

Year 3: Remeasurement #2 is conducted during the second 12-month period of the 24-month look-back period. Quantitative analysis is required. Qualitative analysis is required if goals are not met. This is data point 3.

SECOND RENEWAL SURVEY

*Note: In this scenario, the organization uses the same measure. Follow the same rules on analysis.

Year 1: This measure (metric) is a remeasurement if the measure stays the same.  

Year 2: Remeasurement #1 is conducted. This is data point 4.

Year 3: Remeasurement #2 is conducted.  This is data point 5.

What NCQA Health Plan Standards Does Measurement and Remeasurement Apply to?

Measurement and remeasurement requirements are found in the standards on network, member experience, and population health management:

• NET 1: Practitioners Providing Primary Care, Specialty Care, and Behavioral Health
• ME 6: Member Experience and Personalized Information
• ME 7: Member Experience Opportunities for Improvement
• PHM 6: Population Health Management Impact

How MHR Can Assist

• We train in Analysis
• We offer templates for Analysis
• We guide you in improvement measures through our consultation

Visit our Products page to schedule training and access our templates.

If you are not an MHR client yet, schedule a Discovery call through our Contact page, and read about How We Work and the types of Organizations we guide to NCQA Accreditation. We would love to discuss how we differ from other NCQA consulting firms!

MHR implements a thorough quality review process for all blogs. This blog features insights from Kim Carpenter Petit. Learn more about MHR’s Independent Consultants at managedhealthcareresources.com/AboutOurConsultants.