HEDIS measures are business-critical indicators tied to your health plan’s revenue, compliance, and reputation.
“More than $300 million in value-based payments hinge on quality measures like HEDIS.” ~ NCQA, 2024 (Source)
And missing them? That’s like leaving money, credibility, and patient trust on the table.
In a world where Stars Ratings determine bonuses and NCQA scores impact your next contract, gaps in HEDIS tracking can be a silent killer.
But here’s the kicker: HEDIS gaps don’t show up at year-end. They build quietly, month after month. Let’s break it down.
What are HEDIS measures in healthcare?
HEDIS (Healthcare Effectiveness Data and Information Set) measures are a set of standardized performance metrics used by more than 90% of U.S. health plans.
Created by NCQA, they evaluate everything from cancer screenings to chronic disease management.
In short, they answer: “How well are we taking care of our members?”
Why are HEDIS measures important in healthcare?
Hedis measure are importance because they directly influence:
- Stars Ratings
- Reimbursement incentives
- Accreditation standings
- Member trust and satisfaction
Miss enough, and you’re in the red both financially and reputationally.
How HEDIS measures work
Most plans collect HEDIS data through:
- Claims and encounter data
- Chart reviews (hybrid reporting)
- Electronic clinical data systems (ECDS)
These measures are reported annually, but the tracking has to happen in real time to close gaps effectively.
“Health plans that wait until Q4 to review gaps miss up to 40% of eligible closures.” ~ Health Affairs, 2023 (Source)
What are missing HEDIS measures in healthcare?
It’s not just about data entry mistakes or missing documentation.
Missing HEDIS measures issues in healthcare stem from:
- Incomplete or late data capture
- Poor coordination between providers and payers
- Manual tracking errors
- Gaps in chart review processes
What is the Missing HEDIS measures process in healthcare?
It’s the set of failures that prevent valid data from being captured and reported on time, leading to unclosed care gaps.
Role of AI in closing missing HEDIS measures
Traditional chart reviews can’t keep up with scale or complexity. AI is changing the game.
What HEDIS measures looks like with AI:
- Automated detection of care gaps
- Real-time alerts for coding/documentation errors
- Centralized dashboards for Stars and NCQA teams
AI tools improve speed, accuracy, and outcomes. But not all AI is created equal.
How RAQ+ solves the HEDIS problem
At Bulwark, we purpose-built RAQ+ to make HEDIS care gap closure smarter, faster, and easier.
Here’s what it does:
Identifies and closes HEDIS care gaps in real time
No more waiting till year-end. RAQ+ actively monitors patient records to detect and flag missing HEDIS data as it happens.
Monitors quality metrics continuously
Real-time dashboards give you live visibility into performance across Stars, NCQA, and internal benchmarks.
Aligns documentation with NCQA and CMS standards
RAQ+ cross-validates documentation to ensure every care gap is coded and recorded accurately.
Drives Stars Ratings and RAF improvement
Better data capture = better Stars scores = better revenue.
FAQs:
What are HEDIS measures in US healthcare?
HEDIS measures are standardized performance metrics used to track care quality and compliance in U.S. health plans.
What happens if we miss HEDIS measures?
You risk lower Stars Ratings, reduced CMS incentives, rework costs, and reputational damage.
Is fixing HEDIS measures cheap or expensive?
Fixing it late is expensive. Addressing gaps in real-time with AI tools like RAQ+ is much more cost-effective.
How often should we track HEDIS gaps?
Ideally, continuously. Waiting till Q4 leads to missed opportunities and rushed reviews.
What role does AI play in quality reporting?
AI helps identify care gaps faster, improves accuracy, and reduces manual effort in HEDIS tracking.
Why do HEDIS gaps often go undetected?
Because traditional systems aren’t built to flag real-time issues or automate data extraction from charts.
Can RAQ+ integrate with our existing systems?
Yes, RAQ+ is designed to integrate with EMRs, data warehouses, and quality dashboards.
Conclusion:
In value-based care, quality is currency.
Every unchecked HEDIS gap chips away at your bottom line. And it’s not just money. It’s missed performance bonuses, lost accreditation points, and lower member satisfaction.
The fix isn’t a spreadsheet.
It’s RAQ+.
✅ Real-time HEDIS tracking
✅ Automated gap closure
✅ Enterprise-wide visibility
Let us show you what smarter HEDIS management looks like. Book a demo with Bulwark.
