Turning CMS’s 24 proposed quality measures into an advantage

CMS is signaling a future where Medicare quality improvement measurement is more digital and outcomes focused. Centering on chronic conditions, safety, and timely follow upon abnormal results should help move forward the goals of value-based care.Still, it requires payers to move quickly and nimbly to keep pace. To become or remain successful, payers must modernize their data, workflows, and provider engagement strategies so they can turn CMS’s proposed changes into better member outcomes, higher ratings, and more efficient operations.

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An overview of CMS’s recent proposed measures

CMS has published a list of 24 quality and efficiency measures under consideration (MUC) as part of its annual pre-rule making process for Medicare. Eight measures already in use areback on the list due to significant specification changes, and two are being evaluated for use across additional Medicare programs. This signals that plans cannot assume “business as usual”, even on familiar specs.

Every one of the 24 measures uses at least one digital data source, and 23 rely exclusively on digital submissions, aligning tightly with CMS interoperability and digital quality priorities. The measures cluster around chronic conditions and related acute events, patient safety, timely follow up for cancer screening, person-centered care, and seamless care coordination. They also prioritize diagnoses like acute myocardial infarction, heart failure, sepsis, pneumonia, malnutrition, dialysis, and emergency access.

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*This measure is currently in use, but it is included on the 2025 MUC List because it is undergoing substantial changes to specifications.
Source: Partnership for Quality Measurement (P4QM),“PRMR measures”

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Why CMS’s changes matter for payers and quality leaders

For Medicare Advantage plans and other risk-bearing organizations, CMS’s proposed measures expand the pressure to perform well on complex outcomes like sepsis mortality, post-acute events, and chronic condition management—not just process compliance. At the same time, CMS’s digital-first stance means that fragmented, manual record workflows will increasingly become a liability.

Quality teams already face compressed HEDIS timelines and rapidly evolving requirements from CMS and NCQA. Star Ratings and bonus dollars are directly tied to measure performance and member experience.Adding new or substantially revised measures around acute care, safety, and timely follow-up will intensify operational strain for teams – especially for those that rely on seasonal, spreadsheet-driven programs instead of year-round, data-driven quality improvement.

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Reveleer’s perspective on CMS’s direction

CMS’s direction is validation that year-round, digital quality improvement is no longer optional. The focus on specific quality outcomes aligns directly with Reveleer’s experience that payers need continuous visibility into care gaps and outcomes, not episodic audits six weeks before submission.

The digital requirement behind all 24 measures reinforces the need to ingest, normalize, and interpret data from multiple sources at scale then tie that back to clinical source documentation in a traceable way. This includes EHRs, HIEs, labs, and scanned records.

Reveleer’s AI-driven evidence validation and retrieval capabilities (called EVE™) were built for exactly this shift. Our technology guides abstractors to the right data quickly and links insights to clinical documentation. That way, plans can defend performance under audit while scaling more complex measures.

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The evolution of CMS’s focus on quality measures

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How Reveleer helps payers win in a digital, outcomes-first world

The Reveleer Quality Improvement Solutions helps risk-bearing organizations accelerate HEDIS compliance and extend that same infrastructure to year-round management of measures. By unifying retrieval, abstraction, and clinical quality workflows in the ReveleerPlatform, payers can expand coverage of digital and traditional data sources.Reveleer customers have improved abstraction efficiency by up to 75 percent and sustain an average 88 percent accuracy rate on top measures, directly supporting the level of precision the new CMS measures will require.

Care Gap Manager adds continuous, program-based oversight of care gaps across the measurement year. This visibility allows quality teams and provider groups to collaborate earlier on issues like timely mammogram follow-up or colorectal cancer tests instead of scrambling at year end. Providers can review open gaps, submit evidence, and track prior submissions in real time—improving the provider experience, supporting more reliable closure of high-impact gaps, and positioning plans to perform on outcomes rather than process.

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What makes Reveleer different in this environment

Always-on quality programs require transparent, evidence-linked AI that quality leaders can trust and audit. Designed for this reality, Reveleer moves beyond seasonal, HEDIS-only projects and black-box NLP.Customers use the same underlying retrieval and abstraction infrastructure across quality and risk adjustment, reducing redundancy and resulting in more complete patient records. This approach helps plans improve performance on complex Medicare measures involving chronic disease and post-acute outcomes.

HEDIS engine-agnostic by design, the platform integrates quickly with existing engines or internal systems, making it easier for payers to align with CMS’s digital interoperability priorities. The approach goes beyond meeting new CMS specifications. Proven results, including double-digit improvements in managing chronic conditions, higher retrieval rates, and documented revenue lift, show how regulatory change can become a competitive advantage for plans willing to modernize now.

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Frequently asked questions

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What are the new CMS proposed quality measures for 2025?

CMS has proposed 24 measures focusing on chronic conditions(sepsis, heart failure, pneumonia) and patient safety, with a nearly total reliance on digital data.

How does the CMS 2025 proposed rule affect Medicare Advantage plans?

It increases pressure to perform on complex outcomes rather than just process compliance and makes fragmented, manual record workflows a liability.