Traditional HEDIS submission is being replaced, and NCQA’s former certification program has shifted to a Measures Validation model. The revised workflow now is to:
Completing this cycle can take up to a year, before submissions are officially declared as submittable HEDIS Rates.
Low HEDIS Rates impact STAR Ratings, which in turn impacts Payers’ bottom line. Payers that automate the quality-measure lifecycle (data ingestion through submission) can control costs while improving scores.
Vendor solutions for Quality Measures that can automate and streamline the whole quality lifecycle will support Payers shift to Digital HEDIS, while also reducing operational costs and improving results.
Your first step is to confirm that any vendor you consider is ready for Digital Quality Measurement (Digital HEDIS and beyond).
Vendor Comparison: Digital HEDIS Capabilities
The table below highlights 7 capabilities that we believe are essential foundations for a vendor. We have assessed other vendors’ capabilities compared with that of Smile Digital Health
| Capability | Other Vendors | Smile Digital Health |
| Traditional (Legacy) HEDIS Certification – (Sunsetting by NCQA) | Certified (transitional) | Transitional |
| New NCQA-Validated Digital Measures | Not Started | Yes; 35 measures validated; 4 more in queue1 (as of July 2025) |
| FHIR + CQL-Native Engine | Partial Supported | In production for 8+ years |
| Real-Time Quality Analytics | Limited | Automated + Scalable |
| Digital Content Alignment (DCS) | Not integrated | Fully Integrated |
| Benchmarking + Reporting | Available | Available |
| Enterprise-scale Evaluation (millions of members) | Unclear | Proven Scale (5M members, 5B datapoints) |
| Policy codification (medical, administrative, benefits rules) | Manual or ad hoc | Automated, FHIR-normalized |
Why Smile
As the first and only FHIR-CQL engine with NCQA-validated measures, Smile is defining industry standards for digital quality measures.
Single-platform Lifecycle: Smile’s dQM for HEDIS Measures is a single-point solution that covers the entire quality measure lifecycle, from data ingestion to submission.
Early Validation Leadership: We are the first and only vendor who has already received validation on 35 measures, with an additional 372 awaiting validation.
Scale and Reach: Our deep expertise in FHIR, CQL and interoperability is unparalleled, and our solutions serve over 27 US Payers and touch 100 million lives.
Rapid updates and compliance: Smile’s engine adapts quickly when NCQA revises or adds measures and remains 100% CMS-compliant.
Ready to build your Clinical Quality Intelligence roadmap?
1,2 Figure current as of July 2025, based on NCQA public listings. Updated quarterly to maintain accuracy.