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Smile dQM - Measures for HEDIS®


Transition to Digital Measures for HEDIS

The Challenge

HEDIS reporting is still largely a labour-intensive, costly, retrospective process plagued with fragmented, unstructured, low-quality data locked in rigid IT systems.

With over 90 HEDIS measures to report on—more than 20 directly tied to reimbursement—underperformance carries a real financial risk. For example, a health plan covering 100,000 members could lose up to $17 million by failing a single measure. Poor results jeopardize CMS Star Ratings, bonus payments, and overall competitiveness.

As regulatory demands grow and value-based care moves closer to reality, payers need a scalable, future-ready approach to quality measurement. The approach must shift the current reactive, labor-intensive, annual HEDIS submission process, into a proactive, automated, continuous process. 

Introducing: Smile dQM - Measures for HEDIS

Smile dQM - Measures for HEDIS is an end-to-end digital quality measurement solution that automates the ingestion of disparate health data, the execution of HEDIS measure logic, and the submission of results, all powered by open standards (FHIR®, CQL) on a scalable data platform.

Smile is the first and only organization to receive NCQA validation for specific measures with its dQM Solution.

4 Measures Validated
28 Measures Submitted

Smile, NCQA and the Future of Quality Measures

Smile is currently undergoing NCQA validation for its dQM Solution to run digital HEDIS measures. This validation verifies that Smile’s FHIR and CQL engine has successfully run NCQA Digital Content Services (DCS) measures and produced accurate and consistent results.

US payer organizations can now move forward confidently with Smile dQM - Measures for HEDIS, as it accurately generates digital HEDIS measurements for parallel testing, in order to certify for digital HEDIS submission and reporting.

In addition, Payers who license Smile’s dQM -Measures for HEDIS solution are future-proofed for the evolving shifts in digital quality reporting. NCQA has targeted the year 2030 to no longer accept traditional methods of measurement and transition entirely to digital. 

Smile dQM for HEDIS solution leverages FHIR and CQL. Our engine boasts break-through performance processing data for over      5 million member patients. 

5 Billion+ Data Points
80 Measures
< 12.5 Hours Time Taken

Key Benefits of Smile dQM - Measures for HEDIS

Smile dQM - Measures for HEDIS is unified in one fully interoperable Health Data Platform without expensive proprietary custom interfaces. Its FHIR and CQL engine is capable of evaluating complex measure logic at scale.

✓ FHIR-native integration includes data ingested from HL7v2, C-CDA and a variety of other formats (interfaces with the Smile Health Data Platform).
✓ Inclusion of an all-in-one comprehensive library of quality measures, extendable to NCQA HEDIS, CMS MIPS, region-specific, custom measures 
✓ Configurable for continuous evaluation and monitoring in real-time throughout the year.
✓ User-friendly intuitive UX and workflows for quality analysts and administrators, as well as simplified reporting and submission tools

Why Choose Smile dQM - Measures for HEDIS

Smile’s dQM - Measures for HEDIS is built for scale, automation, and compliance. Our solution supports the transition to digital HEDIS, enabling Payers to leverage clinical and operational data for predictive, real-time, continuous decision making.

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End-to-End, FHIR-Native Workflow

From ingestion to gap analysis and reporting, our solution is fully automated, standards-based, and extendible—reducing operational burden and enhancing data trust.

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Enterprise-Grade Scale and Performance

Proven ability to evaluate complex measure logic at scale; benchmarked at 5 billion data points (for 5 million members/ patients) for 80 measures in under 12.5 hours.

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Automated, Real-Time Results

Eliminate labour-intensive, time-consuming workflows. Smile’s CQL engine automatically calculates HEDIS measures within minutes of data arrival, enabling near real-time quality monitoring.

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Predictive Care-gaps

Our solution generates granular patient-level measure results (FHIR/JSON) feed into analytics and power predictive care-gaps, aligning with NCQA’s vision.

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Certified and Compliant

Directly integrates NCQA’s official digital measure content (FHIR/CQL), ensuring alignment with the most current, certified HEDIS logic (i.e. no custom re-coding required).

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Ready for the Digital Future

As an NCQA Early Adopter, Smile natively consumes DCS packages out-of-the-box, streamlining your transition to fully digital measurement by 2030.

Smile’s flexible implementation supports Payers where they are at—a plug-and-play deployment can integrate with existing systems, or a self-service configuration for customized needs. 

Ready to Transform Your Quality Life-cycle and Lead the Industry?

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