Many health plans wrapped up Measurement Year (MY) 2025 with a smoother HEDIS® season than ever before. The organizations that performed best weren't necessarily those with the largest teams or budgets—they were the ones with integrated data, aligned workflows, and the ability to identify and act on quality opportunities earlier.
Best practices from a successful season
For many health plans, MY 2025 brought an unexpected outcome: fewer fire drills. The most successful organizations relied on repeatable steps focused on:
- Integrated clinical and quality data
- Aligned teams around clear priorities
- Chart review productivity reporting
- Population-level measures dashboards
- Established repeatable workflows that reduced operational friction throughout the season
High-achieving plans started by identifying the right opportunities by using HEDIS logic and integrated data sources to pinpoint the gaps that matter most. Effective approaches centered on opportunities where both impact and intervention are possible, targeting outreach at the provider, care manager, or member level depending on where change can occur most effectively.
Next, operationalizing those insights was key during MY 2025. Analytics may reveal performance gaps, but improvement happens when those findings are embedded directly into workflows. Plans that consistently outperform their peers translate data into outreach campaigns, care management activities, and provider engagement efforts with clearly defined accountability.
Standardization is equally important. Quality initiatives only create value when the work performed is accurately reflected in reporting. Aligning documentation and coding practices with NCQA-approved value sets helps ensure that quality improvements appear in measure results.
Finally, leading health plans embrace continuous measurement. They evaluate intervention effectiveness, monitor gap closure rates, assess outcomes, and create feedback loops that help refine future strategies. Over time, this transforms quality programs from a series of one-off campaigns into a scalable operating model built around continuous improvement.
Looking ahead as quality programs continue to face growing pressure
While many plans had a successful reporting year, quality teams continue to face budget pressures, staffing constraints, and changing member populations. As resources become more limited and member needs become less predictable, plans are shifting toward earlier intervention, year-round gap closure, and more proactive performance management. Many are also investing in forecasting and scenario modeling capabilities to identify risks and opportunities sooner, allowing teams to focus resources where they can have the greatest impact.
Digital quality measurement can help plans intervene earlier, close gaps year-round, and make better use of limited resources. Yet during Cotiviti's recent webinar recapping HEDIS MY 2025, 93% of respondents said they had either not started preparing FHIR data for digital quality measures (dQMs) or had made only minimal progress, citing budget, resource, and knowledge constraints as the primary barriers.
Overcoming these barriers requires an enterprise-wide approach. By building on an existing rock-solid foundation and partnering with organizations that can support traditional, state-specific, and digital measures from a single data foundation, health plans can seamlessly meet current reporting requirements while scaling their digital quality strategy.
We are excited at Cotiviti to meet our customers where they are at and remove barriers to entry for the benefit of all, allowing for much needed iteration to take place and feedback to be gathered well ahead of the 2030 deadline.
Preparing for what comes next
As the ultimate 2030 deadline for digital quality measurement approaches, consider these short- and long-term strategies.
| Near-term | Next 90 days | Next 90–365 days |
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Webinar: HEDIS Tech Specs
As Cotiviti’s Quality Decoded webinar series continues, register for the next webinar on Thursday, September 10 as our experts walk through the annual publication of confirmed measure updates for HEDIS® MY 2027. Join us as we:
- Key updates and confirmed changes in the HEDIS MY 2027 Technical Specifications
- How evolving measure requirements may impact reporting, compliance, and quality program strategies
- Best practices to help your team prepare for the upcoming HEDIS measurement year with confidence
HEDIS® is a registered trademark of the National Committee for Quality Assurance.
