Decoding HEDIS® MY 2024 for fulfillment in MY 2025

Health plans are below rising strain to ship measurable high quality enchancment whereas navigating regulatory shifts, operational complexity, and rising member expectations. Whereas HEDIS^® Measurement Yr (MY) 2024 is now within the rearview mirror, the work of high quality enchancment by no means stops.

The main focus now shifts to low season tasks and making ready for the subsequent cycle. An intensive post-season evaluate—analyzing what labored, figuring out delays, and uncovering knowledge gaps—will help plans develop focused methods to optimize future efficiency. By reflecting on challenges and achievements of MY 2024, staying forward of key adjustments for the upcoming season, and constantly making ready for digital high quality transformation, plans can set themselves up for fulfillment in MY 2025 and past. Listed here are a couple of methods that may assist.

Strengthening retrieval and shutting gaps

Medical document retrieval stays a cornerstone of HEDIS success for hybrid measures. A number of foundational methods can enhance effectivity and outcomes, together with strengthening supplier knowledge, consolidating outreach efforts, and investing in digital connectivity. Whereas digital retrieval is important, flexibility stays key—assembly suppliers the place they’re, whether or not by way of digital or conventional strategies, can considerably enhance retrieval charges.

Equally vital is constructing a suggestions loop with suppliers. Sharing high-level outcomes fosters transparency and encourages continued engagement. Throughout the plan, cross-departmental collaboration can be essential. By breaking down silos and sharing duty throughout groups, plans can streamline communication, enhance knowledge seize, and cut back the necessity for in-season chart retrieval.

When IT involves hole closure, begin early. Partaking suppliers originally of the measurement 12 months permits extra time to shut gaps and enhance outcomes. Plans ought to prioritize high-impact measures, leverage Technology to cut back guide work, and provide versatile retrieval choices, combining digital and conventional outreach strategies, to reduce supplier burden.

Navigating timeline and measure adjustments

Persevering with the development noticed lately, a number of Nationwide Committee for High quality Assurance (NCQA) audit deadlines will transfer barely earlier for MY 2025, although the ultimate submission deadlines will happen two days later (Determine 1). In the meantime, multiple measures are transitioning to digital scientific knowledge techniques(ECDS) solely reporting, together with cervical most cancers screening(CCS), childhood immunization standing(CIS), and immunizations for adolescents(IMA), whereas the attention examination for sufferers with diabetes(EED) measure is shifting to administrative-only reporting.

New measures are additionally being launched, reminiscent of blood strain management for sufferers with hypertension(BPC-E), primarily transitioning the controlling hypertension measure into ECDS and increasing eligibility standards, and two mammogram-related measures. These adjustments would require cautious planning and knowledge readiness to make sure correct reporting and compliance.

Submission Job	MY 2024 Deadline	MY 2025 Deadline
Cease all nonstandard supplemental knowledge assortment	February 28, 2025	February 27, 2026
Auditor approval of all supplemental knowledge	March 28, 2025	March 27, 2026
Preliminary charges submitted in IDSS	April 11, 2025	April 10, 2026
Audit evaluate conferences accomplished	April 25, 2025	April 24, 2026
Medical document abstraction finalized for MRRV	Might 2, 2025	Might 1, 2026
Preliminary charge evaluate responses accomplished	Might 9, 2025	Might 8, 2026
MRRV evaluate accomplished	Might 23, 2025	Might 22, 2026
Plan-locked submissions in IDSS	Might 30, 2025	Might 29, 2026
Medicare patient-level element submitted to CMS	June 13, 2025, 9:00 pm ET	June 15, 2026, 9:00 pm ET
Auditor-locked submissions in IDSS	June 13, 2025, 9:00 pm ET	June 15, 2026, 9:00 pm ET

Determine 1. NCQA audit timelines for MY 2024 and MY 2025.

Embracing the digital future

The transition to digital high quality measurement is nicely underway, with a goal of full digital-only reporting by 2030. This shift breaks down into two key parts: measure logic and knowledge mannequin. Conventional measures depend on vendor-coded logic and proprietary knowledge fashions, whereas digital high quality measures (dQMs) use standardized Medical High quality Language (CQL) and the FHIR knowledge mannequin.

This shift guarantees better standardization, interoperability, and effectivity, however IT additionally requires preparation. Latest polling of Cotiviti shoppers revealed that almost all of plans both haven’t began or are simply getting began on their  FHIR knowledge transformation, with price, lack of inside data, and lack of strategic alignment cited as key limitations. When requested on the current Cotiviti Shopper Convention 2025 to explain the FHIR knowledge accessible for high quality reporting, practically two-thirds respondents indicated they’d not but began integrating FHIR knowledge in any respect.

Which of the under statements finest describes the FHIR knowledge you may have accessible for high quality reporting?

Determine 2. Cotiviti Shopper Convention 2025 ballot of high quality shoppers.

Health plans ought to take proactive steps now, reminiscent of figuring out inside groups already working with FHIR, assessing knowledge gaps, and constructing strategic alignment. Plans should work to assist guarantee they’ve the info they should not solely keep the charges they produce right this moment, however exceed them sooner or later.

An motion plan for HEDIS success

Cotiviti is actively supporting shoppers by way of the transition to digital measurement with coaching, instruments, workflows, and a roadmap for parallel reporting. As your group works to satisfy the 2030 deadline, contemplate this phased method:

• Within the brief time period: Take stock of FHIR readiness and consider downstream wants.
• Over the subsequent 90 days: Attend a coaching on FHIR, construct inside partnerships, and start budgeting for crucial infrastructure.
• Over the subsequent 12 months: Monitor state-level digital reporting necessities, perceive your knowledge gaps, develop a plan for parallel reporting, and start executing your technique with continuous refinement.

Reflecting on a 12 months of milestones

Cotiviti’s High quality and Stars shoppers achieved vital HEDIS success within the lately concluded MY 2024 season. Each HEDIS consumer submitted forward of the deadline, all retrieval tasks exceeded their objectives, and 100% of shoppers utilizing Cotiviti for medical document abstraction handed the primary spherical of medical document evaluate validation (MRRV). These outcomes underscore the energy of Cotiviti’s partnerships and the worth of early planning and collaboration.

With Cotiviti’s High quality Intelligence answer recently certified by NCQA for MY 2025, this 12 months additionally marks Cotiviti’s twenty fifth consecutive certification as a HEDIS vendor—a milestone that speaks to our long-standing dedication to high quality and innovation.

HEDIS^® is a registered trademark of the Nationwide Committee for High quality Assurance (NCQA).