Year-round HEDIS® strategy excellence: Best practices

The most successful health plans have moved beyond treating HEDIS as a once-a-year scramble. Instead, they’ve embraced a year-round discipline that blends proactive planning, agile data management, and cross-functional teamwork. This approach not only drives better results at submission but also fosters a culture of continuous quality improvement that pays dividends across the organization.

Off-season (June–December)

The months following HEDIS submission are a critical window for reflection, recalibration, and innovation. Rather than winding down, top-performing teams use this period to lay the groundwork for the next cycle.

Post-season analysis and debrief

The first step is a rigorous debrief. Teams review final metrics, analyze where targets were met or missed, and dig into the root causes behind both successes and setbacks. This isn’t just about looking at rates; it’s about understanding workflow bottlenecks, data gaps, and process breakdowns. By bringing together quality, IT, analytics, and clinical leaders, organizations can ensure that lessons learned translate into actionable improvements.

Building cross-functional HEDIS improvement teams

Year-round HEDIS excellence depends on collaboration. High-performing organizations break down silos by establishing cross-functional teams that include quality, provider relations, IT, analytics, and care management. These teams meet regularly to review progress, share insights, and coordinate interventions, ensuring that quality improvement is everyone’s responsibility, not just the HEDIS department’s.

Data analytics upgrades

The off-season is the ideal time to invest in healthcare analytics infrastructure. Plans are increasingly leveraging advanced tools to identify care gaps in real time, monitor performance trends, and project future results. Integrating artificial intelligence and machine learning can help automate evidence validation, flag missing documentation, and prioritize outreach, making the next HEDIS cycle more efficient and less reactive.

Developing and executing a comprehensive, year-round quality strategy

With insights from the debrief and upgraded analytics, teams can build a comprehensive strategy that spans the entire year. This strategy should include timelines for provider education, member outreach, technology enhancements, and regular performance checkpoints. By mapping out the full cycle, organizations can move from reactive fire-fighting to proactive, strategic quality management.

In-season (January–May)

As the official HEDIS season opens, the focus shifts to flawless execution. The groundwork laid in the off-season pays off here, enabling teams to move quickly and confidently.

Efficient chart retrieval

With the reduction of hybrid measures and the rise of digital reporting, efficient chart retrieval is more important than ever. Leading plans are automating requests, integrating directly with provider EHRs, and leveraging digital platforms to minimize manual effort. Provider engagement is key; clear communication, education, and even incentives can ensure timely, accurate documentation.

Real-time quality measure tracking and daily performance monitoring

Gone are the days of waiting for monthly or quarterly reports. Today’s quality teams monitor measure performance daily, using dashboards and alerts to track progress and address issues as they arise. This real-time visibility enables rapid course correction and ensures that improvement efforts stay on target.

Integrating multiple data sources

No single data source tells the whole story. The best-performing organizations pull from a wide array of inputs: medical records, health information exchanges (HIEs), claims, pharmacy, and lab data. Seamless integration and normalization of these sources are essential for capturing every opportunity to close care gaps and validate evidence.

Staying current with NCQA requirements and technical specifications

Finally, HEDIS is a moving target. Each year brings new specifications, measure updates, and technical requirements. The most agile teams dedicate resources to monitoring NCQA releases, attending webinars, and updating internal protocols as changes arise, ensuring there are no surprises when audit season arrives.

CMS star ratings changes: Why quality can’t wait

The latest CMS proposed rule reshapes the Medicare Advantage Star Ratings program in ways that raise the stakes for year‑round HEDIS and value‑based care performance. CMS is proposing to streamline the measure set by removing 12 measures—many of them operational, administrative, or topped‑out process and experience metrics—and shifting attention toward clinical care, outcomes, and patient experience where plans still vary in performance. At the same time, CMS proposes to keep the historical reward factor and not proceed with the Health Equity Index reward, which concentrates incentives on consistently high performance across the remaining, more outcomes‑heavy measures.  

For value‑based care arrangements, this means fewer “easy” points from high‑performing administrative measures and much more dependence on closing clinical gaps, managing chronic conditions, and improving patient‑reported experience. CMS plans to remove measures such as Diabetes Care – Eye Exam, Statin Therapy for Patients with Cardiovascular Disease, and Members Choosing to Leave the Plan from Star Ratings while retaining related clinical outcome and adherence measures, so contracts that relied on broad measure portfolios will have less buffer if performance slips midyear. Because Star Ratings directly drive quality bonus payments and rebates, even small declines tied to the leaner measure set can translate into fewer dollars to fund supplemental benefits and population‑health programs that underpin VBC strategies.  

These changes make a “HEDIS season” mindset obsolete. When measure sets are smaller, cut points are more volatile, and outcome measures carry greater weight, plans cannot afford to wait until chart‑chase season to find and fix problems. Instead, they need always‑on data integration, daily measure monitoring, and cross‑functional teams that can rapidly adjust outreach, care management, and provider workflows as soon as trends emerge. In practice, that means using the off‑season to hard‑wire prospective, digital‑first quality workflows into routine care—and using the in‑season window to fine‑tune, not to play catch‑up.  

To dive deeper into year-round HEDIS and Star Ratings strategy, download our guide, Reveleer HEDIS Best Practices. It walks through detailed workflows, data strategies, and real-world examples to help your team operationalize continuous quality improvement across the full measurement year.

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