Unify Your Data.
Align Every Team.
Smile Omni is a FHIR®-native and CQL engine that unifies data ingestion, quality and compliance at enterprise scale.
NCQA 2026
October 4-7, 2026
Georgia World Congress Center,
Atlanta, Georgia
Booth: #228
Book a 15 minute Digital Quality conversation with a Smile Expert
From Digital HEDIS® to Intelligent Health:
A Modernization Journey for Payers
Quality Today: The Case for Modernization
Payers are entering a period of significant change in how quality is measured, managed, and operationalized. Quality programs today depend on manual chart-chasing across fragmented data sources, retrospective reporting, and administrative processes that limit the ability to deliver high-value and appropriate care on time, and end up costing Patients, Providers and Payers.
Today, Payers face four interconnected challenges:
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Retrospective quality measurement: Performance is assessed months after the measurement period, preventing timely intervention.
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Limited digital coverage: Most quality programs still rely on hybrid or traditional approaches, creating significant administrative and operational burden.
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Increasing transition complexity: Moving from hybrid to digital measures requires changes across data, technology, governance, quality operations, and clinical workflows, and not simply the adoption of a new measurement tool.
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Fragmented quality infrastructure: Custom, state, regulatory, and enterprise measures are often developed and managed as separate technology builds, creating redundancy, duplication, rework, and excess costs.
At the same time, increasing pressure on quality performance, compliance and interoperability initiatives, and financial constraints now require Payers to have access to a timely, trusted, actionable quality intelligence engine.
The Modernization Journey:
From Measurement to Intelligence
Quality modernization is more than another technology implementation layered onto an already complex patchwork of solutions.
It is a progression in which the same trusted data and computable quality foundation supports increasingly sophisticated use cases, without manual burden, costs, duplication and rework. This progression runs across three stages:
Build the reusable data foundation required for Digital HEDIS and continuous quality measurement.
This phase focuses on establishing the governance, data, and technology capabilities required to move beyond retrospective and hybrid quality processes.
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Establish enterprise cross-governance between quality, clinical, IT, security, compliance, operations, and risk management teams.
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Ingest legacy data in any format into a FHIR-native architecture, that returns measure results in minutes rather than batch cycles.
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Create a trusted, enterprise-wide data foundation using FHIR® and CQL open standards for structured data and computable quality logic.
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Author all HEDIS measures into a validated, deterministic, computable format, starting with the most common or high-value measures.
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Establish a strategy for managing hybrid measures while preparing for the transition to digital measurement.
Outcome: Quality becomes a proactive capability for improving care, outcomes, and value for members and populations.
Extend the same digital foundation across quality programs and enterprise use cases.
Once digital HEDIS measurement is established for a few or all measures, the same foundation can remove the legacy silos across state and jurisdictional custom measures, compliance, risk, and care delivery. In this phase, Payers:
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Unify and validate enterprise source data once, for use across multiple initiatives.
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Author and execute custom, state, and jurisdictional digital measures using the same standards-based approach, without paywalls or significant rework.
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Apply computable measures consistently across populations and programs.
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Establish greater data liquidity, ownership, and autonomy.
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Access population-level insight analytics.
Outcome: Quality becomes an enterprise capability rather than a collection of individual programs, measures, and workflows.
As pioneers of FHIR and CQL implementations globally, Smile is moving towards the goal of delivering fully operationalized clinical intelligence well before NCQA’s 2030 date.
With trusted data and continuously executable quality logic in place, Payers can begin embedding quality intelligence directly into operational and clinical workflows, by:
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Identifying care gaps and quality risks continuously, within clinical workflows.
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Enable payer-provider collaboration using shared data and consistent logic.
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Generate actionable member and population insights.
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Identify opportunities to improve performance before they affect quality outcomes.
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Support clinical decision-making at the point of care.
Outcome: Quality becomes an enterprise capability rather than a collection of individual programs, measures, and workflows.
Note: * Denotes in-development
What Phase of the Modernization Journey Are You At?
Smile OmniQ: Your Quality Foundation
OmniQ provides a unified quality layer that runs logic for Digital HEDIS and custom measures, and clinical intelligence.
Wherever Payers are on their modernization journey, Smile OmniQ builds and supports Payer digital transformation.
Measures for HEDIS
Instant, audit-ready HEDIS scores and submission with actionable population analitycs
Custom Measures
Author and execute state, regional, and custom digital measures without rework
Intelligence Hub
Actionable, real-time, member and population insights
Built on a trusted, computable data foundation, OmniQ enables payers to aggregate, calculate, analyze, and operationalize quality measures using FHIR-native data and CQL. The result is a consistent, defensible, and an auditable approach to quality that can evolve as a Payer's modernization strategy matures.
Why Smile: Technology and Implementation
Modernizing quality is not simply a matter of deploying new technology to an existing patchwork of vendor solutions.
Nor should it be a rip-and-replace strategy.
A successful investment in digital transformation of quality requires organizations to change how data is governed, how measures are implemented, how quality and compliance teams operate, and ultimately how intelligence is incorporated into care and operational workflows.
Smile brings the technology and implementation expertise together.
Our approach is designed to work with a Payer's existing ecosystem, and whatever phase of modernization that they are at (even if they have not started). Smile's standards-based architecture ingests and works with existing data environments while establishing the FHIR-native and computable foundation digital quality requires. Our expertise spans the technology, quality, clinical, operational, and governance considerations required to move from digital measurement to a realizing clinical intelligence.
The result is a modernization strategy that can start with the immediate requirements of Digital HEDIS, while establishing the foundation for broader quality, compliance, and clinical intelligence.
Trust is in The Data
Smile dQM Measures for HEDIS has been through comparative testing in real-world (live)
production environments with Payer clients.
Confidence in Digital HEDIS Measures
NCQA's original Digital HEDIS transformation approach required a year of parallel testing to validate digital results against traditional measurement. NCQA now calls this comparative testing, and it is optional.
As Digital HEDIS adoption accelerates, the responsibility for validating digital measure results sits with Payers. Without a clear and proven validation strategy, Payers risk operational delay in validating measure implementations, investigating variance, and establishing confidence in results at scale.
Find out how Smile builds confidence into Digital HEDIS Transformation
Smile Speaker Sessions at NCQA 2026
The Future Of Health Care Is Digital And Thriving
Speakers:
- Rob Reynolds, Smile Digital Health;
- Mike Dolgert, Cigna;
- Daniela Simpson, Wakely Consulting Group
Track: HEDIS® | Digital Quality
For: Healthcare leaders, data and analytics teams, and measurement operations professionals
Objectives: Learn how collaboration evolves from concept to large-scale implementation. Get a playbook that includes the key factors needed to maintain progress amid increasing complexity.
When: Monday, October 5, 2026, 11:30 AM - 12:15 PM
2020 To 2030 And Beyond: How Are We Doing In Advancing Digital Quality
Speakers:
- Reid Kiser, Kiser Healthcare Solutions;
- Bradley Ryan, CoEfficient Health;
- Rob Reynolds, Smile Digital Health;
- Matthew Burton, Smile Digital Health
Track: HEDIS® | Digital Quality
For: Leaders responsible for digital quality, strategy, AI-enabled precision care, and implementation
Objectives: Learn how to actively integrate FHIR and CQL into core architecture and operations. Explore real-world lessons, discuss AI opportunities, including new types of measures, incentive alignment, and multi-context data and content usage.
When: Tuesday, October 6, 2026, 11:15 AM - 12:00 PM
Start Your Quality Modernization Journey
Talk to us about where your organization is today, what needs to change next, and how to build a
quality foundation that can support the journey through 2030 and beyond.