HEDIS quality measures: What we learned this year

As the 2025 HEDIS reporting season comes to a close, we are taking a closer look at everything we learned this year and how to best prepare for next year. It’s important not to consider the remainder of the year the “off-season”. In fact, it’s the perfect opportunity to implement your year-round HEDIS strategy. In this article, we’ll dive into what we learned from reporting HEDIS quality measures this year and how we are looking ahead to make 2026 the most successful year yet.

What changed during HEDIS season 2025

This year, the National Committee for Quality Assurance (NCQA) introduced several changes to HEDIS that affected the way health plans collect and report on quality measures. For successful health plans, it also changed the way they interacted with providers to deliver HEDIS data and drive quality improvement in high-priority areas.

First, NCQA introduced three new measures. These related to assessments following mammograms, abnormal breast cancer assessment follow-ups, and blood pressure control. NCQA also changed some existing measures for eye exams and mental illness follow-ups. Finally, it retired antidepressant medication management and pain assessments for older adults measures.  

In addition to adapting to the change in measures, health plans faced a reduction in hybrid measures, having to report more of their HEDIS metrics through administrative or digital measures via Electronic Clinical Data Systems (ECDS). This left only eight hybrid measures for health plans, meaning plans and providers must take a holistic view of their patient population in HEDIS reporting and continuous care gap closure.

Finally, health plans had to report additional health equity data, including data on gender inclusion and race and ethnicity data stratification. NCQA also instituted broader mental health diagnostic inclusion as well as expanded vaccine types and age ranges for immunizations.

Key lessons from 2025 HEDIS to prioritize for 2026

#1: Work closely with providers. Good documentation is critical to a successful HEDIS season.

Highly accurate and thorough clinical documentation lays the foundation for a successful HEDIS season. Not only does it help ensure the integrity of reported data, reducing the risk of potential audits and even fines, but it also makes sure that all relevant activities are counted toward HEDIS measures, helping plans maximize their scores.

Health plans can work to boost clinical engagement year-round to help improve documentation, and technology powered by artificial intelligence (AI) can help. Payers that work with providers to implement AI-assisted technology at the point of care can help increase the use of M.E.A.T. (Monitor, Evaluate, Assess, Treat) standards. The technology can make suggestions to help close documentation gaps and even verify documentation accuracy. AI-powered technology can also directly reduce provider abrasion by consolidating requests for data, making the process significantly less burdensome for clinical staff. Facilitating superior data collection at the provider level is the critical first step to a successful HEDIS season.

#2: Make sure your workflows are flexible and efficient to make it easier to adapt to new measures.

As HEDIS measures evolve year-to-year, it’s critical that health plans are able to pivot quickly to focus on new quality goals and collect the relevant data to support those goals. Using the time post-HEDIS reporting to identify opportunities to increase the flexibility and efficiency of your existing HEDIS workflows can lay the groundwork for HEDIS success year to year. That way, no matter what changes NCQA introduces, quality teams can quickly pivot, adapt, and scale their operations.  

First, make sure your quality programs have clear data governance and quality processes in place if they don’t already. Insitute nimble teams that can move quickly to categorize drivers of low performance. Those teams should be able to address quality improvement, member engagement, and clinician engagement for each measure.

Finally, identify any areas of inefficiency and determine ways to automate or accelerate those processes so that you can easily scale as you grow. Investing in AI-powered technology can help quality teams automate medical record retrieval and support accelerated coding review, helping HEDIS teams identify gaps in documentation, run analyses, and develop dynamic reports track performance on an ongoing basis.

#3: Move beyond compliance. Uncover hidden areas for improvement.

Racing to comply with HEDIS requirements every year is not a long-term strategy for success. Health plans need comprehensive, proactive quality improvement strategies that can support a range of HEDIS measures and make the transition to digital reporting easier.

Fortunately, by enhancing clinical documentation and implementing more efficient workflows, quality teams can re-focus their time and resources on proactive care gap closure. This requires both prospective and retrospective components. Accelerating and increasing the precision of retrospective measurements helps ensure success, but incorporating prospective risk adjustment to proactively close care gaps is also critical.

To make the next HEDIS season the most successful yet, identify the quality measures with the most potential impact. Start with those that are immediately influenceable as well as lower cost. After identifying those target measures, it becomes easier to engage providers to reach those goals through communication, education, and quality incentives.  

Successful provider engagement requires establishing regular data refresh cycles to help monitor care gaps. AI-powered clinical intelligence technology can help here, too. It can integrate with provider EHRs and deliver insights at the point of care to support care gap closure and documentation. It can also connect with health plan systems, aggregating data from EHRs, HIEs, and other sources to build a 360-degree view of patient health.

#4: Assess your readiness for digital measures.

NCQA requires that plans submit data through both traditional and ECDS reporting mechanisms for at least one year to validate readiness. While some plans are working on this in 2025, others may be preparing to do so in 2026. By 2030, plans must report on all measures through ECDS.  

The HEDIS “off-season” is the perfect time to evaluate digital measure preparedness. Health plans can consider doing a data deep-dive now to make sure core systems are clean. Working to reconcile provider and plan data and conduct a thorough provider scrub, checking for things like provider consolidation and other data points—can help make sure data is clean going into HEDIS reporting season next year.

Plans can also work now with key stakeholders, including their HEDIS auditor, to go through retrieval file extracts and make sure they’re meeting specific data requirements. This helps ensure there aren’t any surprises next year as HEDIS data is audited.

#5: Evaluate your year-round quality improvement plan.

Finally, during the 2025 HEDIS season, we learned how important it is to have a strong quality improvement plan in place year-round. Immediately following HEDIS reporting is the best time to evaluate quality improvement software. Key areas to examine include:

• Past reporting year performance

• Quality of data abstraction

• Documentation gaps or errors

• Strength of data exchange with EHRs

• Relationships with providers and buy-in around measures and documentation

Make sure that the staff accountable for each key area impacting quality improvement (like member engagement, provider engagement, and IT) are at the table to evaluate determine a plan to work together year-round.

Choosing a HEDIS technology partner for 2026

As health plan HEDIS teams sort through their debriefs for 2025, consider choosing the right technology partner to support success in 2026. Powerful HEDIS technology partners leverage AI to help plans:

• Accelerate medical record retrieval and coding review

• Improve clinical documentation

• Develop a 360-degree view of member health

• Generate clinical insights, delivered at the point of care

• Support a year-round quality improvement strategy

Reveleer’s powerful HEDIS solution saved one plan 1,400 hours of manual work and resulted in 26% higher retrieval rates. Interested in evaluating HEDIS partners for 2026? Schedule a demo with Reveleer to tour our Quality Improvement Solution and advanced HEDIS capabilities.