Hybrid HEDIS retirement makes year-round gap closure the strategy

When NCQA retires the hybrid HEDIS® reporting method by measurement year 2029 and moves to full-population Digital Quality Measures (dQM) by 2030, closing care gaps year-round remains the discipline that determines quality and Star Ratings performance. dQM changes how clinical evidence reaches health plans and regulators, yet the work itself stays the same. Plans still find open gaps across the attributed population and close them before the measurement year ends. The provider market continues operating across different levels of interoperability maturity. Large health systems are expanding enterprise FHIR connectivity. Still, year-round provider engagement must reach the groups operating on longer interoperability timelines, with retrieval, chart review, and abstraction feeding their gap data.

CMS Star Ratings, quality bonus payments, and measure-based reimbursement remain tied to documented clinical performance across attributed member populations (42 CFR § 422.162). Health plans still require complete clinical documentation tied to preventive care, chronic condition management, and quality measure completion across the full provider network.

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dQM depends on provider interoperability readiness

dQM scores the full member population from clinical data supplied across the measurement year, drawn from EHR systems, health information exchanges, and registries through standards including HL7 FHIR (CMS Digital Quality Measurement Strategic Roadmap). Large integrated delivery networks continue expanding interoperability infrastructure across enterprise environments. Independent practices, rural clinics, community health centers, and specialty groups continue progressing across different implementation timelines shaped by staffing, capital investment, vendor support, and operational capacity.

Provider organizations operating outside mature interoperability environments are often those serving populations with elevated chronic disease burden, preventive care gaps, and complex longitudinal care histories tied directly to Medicare Advantage measure performance. Encounters occurring within those settings directly impact Star Ratings and quality reimbursement. Clinical evidence from those encounters still requires retrieval, review, and submission.

Hybrid HEDIS reflected the operational structure of the provider market

Hybrid HEDIS supported quality reporting across a fragmented provider ecosystem for more than three decades because the methodology accommodated multiple documentation environments. Structured EHR data, scanned office notes, supplemental records, and manually abstracted documentation all contributed to the same quality measurement framework.

The provider landscape entering 2029 still includes organizations operating across varying levels of interoperability maturity. Health plans maintaining visibility into both FHIR-connected and retrieval-dependent provider populations carry a more complete quality record into the dQM transition period.

Provider networks will continue operating across mixed documentation environments

Most Medicare Advantage networks will enter the dQM transition operating across two provider environments simultaneously. Large health systems with mature FHIR infrastructure will exchange structured clinical data electronically through direct EHR connectivity. Independent practices, rural providers, community health centers, and specialty groups will continue contributing quality evidence through retrieval, chart review, and abstraction workflows tied to supplemental documentation.

Health plans running quality operations continuously across the measurement year identify open gaps earlier, engage provider groups across the full measurement year, and maintain stronger visibility into provider performance before submission deadlines compress operational timelines. Continuous retrieval workflows also give plans flexibility to expand FHIR-based exchange incrementally as provider connectivity matures across the network. A FHIR or dQM engine moves structured data between systems. Identifying which care gaps remain open across the attributed population, and closing them before submission, stays with the health plan across both provider environments.

The transition timeline shaping Medicare Advantage quality operations

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Infrastructure planning determines gap-closure capacity

Planning decisions made between 2026 and 2029 establish the operational structure supporting Star Rating performance during the dQM transition.

Three infrastructure questions shape that planning effort:

• What percentage of the attributed provider network currently operates outside active FHIR connectivity? Quantifying the non-FHIR provider segment establishes the volume of open gaps that a year-round engagement program must close, with retrieval and abstraction supplying the evidence.
• Which measures carry the greatest exposure within that provider segment? Mapping connectivity gaps against high-weight Star Rating measures identifies the areas carrying the largest reimbursement and quality reporting impact.
• Does the organization run a year-round program that engages providers and closes gaps throughout the transition period? FHIR interoperability and year-round engagement work toward the same outcome, complete documentation of clinical performance across the attributed population.

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Closing open care gaps continues driving quality performance

Providers contributing to Medicare Advantage quality scores today continue serving attributed populations throughout the dQM transition period. Health plans still require complete clinical evidence tied to completed services, preventive screenings, chronic condition management, and quality measure documentation across the network.

Organizations maintaining medical record retrieval, abstraction, provider engagement, and interoperability operations together enter the dQM transition period closing more open care gaps before submission and carrying stronger visibility into measure performance across the full attributed population.

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When combined effectively, analytics, care coordination, interoperability, and engagement technologies create a comprehensive digital infrastructure that supports sustainable value-based care success.”
_{- VP of Information Technology, Payer
The State of Technology in Value-Based Care Report 2026}

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Year-round gap closure decides Star Ratings in the dQM era

Reveleer Care Gap Manager is the year-round program platform that produces the continuous evidence flow digital measurement rewards. Provider groups work from a single portal where their current gap list, year-to-date incentive earnings, and remaining opportunity appear in the same session, and they submit supporting evidence through a validated workflow that routes approved documentation back to the plan's quality and risk engines. Health plans using Care Gap Manager see which care gaps remain open earlier in the measurement year, close them before submission deadlines compress, run coordinated outreach from a purpose-built CRM timed to each provider group's current submission activity, and protect Star Ratings bonus eligibility as measures move to full-population digital reporting.

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