HEDIS (Healthcare Effectiveness Data and Information Set) is a foundational tool used by NCQA and CMS for evaluating health plan performance. Today, HEDIS enables payers to monitor quality, identify care gaps, and demonstrate value across six domains:
With over 90 individual measures, HEDIS drives accountability and performance-based reimbursement. As an increasing number of measures shifts to reporting via ECDS, digital-first quality tracking offers an opportunity to:
✓ Broaden measurable care areas
✓ Enable real-time quality improvement
✓ Elevate cost-efficient, value-based care
Low HEDIS scores signal care shortfalls and expose payers to serious risk, including:
Payers need high quality data that is comprehensive, interoperable, and clinically contextual in order to demonstrate quality care. Current collection methods are reactive and admin-heavy, often taking weeks or even months, just to prepare audited submissions for NCQA.