Unlocking HEDIS® 2024 for Success in 2025: A Strategic Guide to Outstanding Performance

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health plans are navigating significant changes in quality betterment measurement, with deadlines shifting and new reporting requirements emerging for 2025. This article details strategies for success.">

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Healthcare Plans Brace for 2025 Changes in Quality Reporting

August 17, 2024

Industry observers report that Health plans are intensifying efforts to enhance quality improvement amidst evolving regulations and escalating member expectations.

Navigating a Dynamic Landscape

The healthcare sector is in constant flux, demanding continuous adaptation from health plans.With the 2024 HEDIS Measurement Year concluded, attention is now firmly on preparation for the next cycle. Thorough post-season assessments are crucial, identifying successes, delays, and data deficiencies to refine future strategies. Staying ahead of changes and embracing digital transformation are vital for success in 2025 and beyond.

Boosting Data Retrieval and Addressing Gaps

Efficient medical record retrieval remains paramount for hybrid measures. Strengthening provider data accuracy,streamlining outreach initiatives,and investing in digital connectivity are foundational strategies. While digital retrieval is essential, a flexible approach-catering to provider preferences-can substantially increase response rates.

Establishing a feedback loop with providers, sharing performance insights, fosters collaboration. Internal cross-departmental teamwork is equally vital, breaking down silos to improve data capture and reduce in-season retrieval demands.

Proactive gap closure, starting early in the measurement year, allows ample time for improvement. Plans should prioritize high-impact measures, adopt technology to automate tasks, and offer multiple retrieval options to ease the burden on providers.

Upcoming Timeline and Measure Adjustments

Following recent trends, several audit deadlines set by the National Committee for Quality Assurance (NCQA) will shift slightly earlier for the 2025 Measurement Year. However, final submission deadlines will be delayed by two days, according to NCQA guidelines. Importantly, several measures are transitioning to electronic clinical data systems (ECDS) reporting only, including cervical cancer screening, childhood immunizations, and adolescent immunizations.The eye exam for patients with diabetes measure will now rely solely on administrative data.

New measures are also being introduced, such as blood pressure control for hypertension, extending eligibility criteria and transitioning to ECDS, alongside two new mammogram-related measures. these changes necessitate careful planning and robust data preparation to ensure compliance and accurate reporting.

Submission Task	MY 2024 Deadline	MY 2025 Deadline
Stop all nonstandard supplemental data collection	February 28, 2025	February 27, 2026
Auditor approval of all supplemental data	March 28, 2025	march 27, 2026
Preliminary rates submitted in IDSS	April 11, 2025	April 10, 2026
Audit review meetings completed	April 25, 2025	April 24, 2026
Medical record abstraction finalized for MRRV	May 2, 2025	May 1, 2026
Preliminary rate review responses completed	May 9, 2025	May 8, 2026
MRRV review completed	May 23, 2025	may 22, 2026
Plan-locked submissions in IDSS	May 30, 2025	May 29, 2026
Medicare patient-level detail 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

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

Embracing Digital Transformation

The shift towards digital quality measurement is accelerating, with a goal of complete digital reporting by 2030. This transition involves standardizing measure logic and utilizing the FHIR data model. Digital quality measures (dQMs) offer increased standardization, interoperability, and efficiency. A recent industry poll reveals that many plans are only beginning to assess their FHIR data readiness, citing cost, knowledge gaps, and strategic alignment as obstacles.

A Proactive Plan for HEDIS Success

A phased approach is recommended: immediately assess FHIR readiness, dedicate resources to training, and develop a strategic plan over the next year. Organizations should monitor state-level digital reporting requirements, identify data gaps, and begin implementing parallel reporting strategies.

Recent Achievements

Clients of leading quality and stars solutions providers have demonstrated significant success in the recently completed 2024 Measurement year, with all submissions ahead of schedule and retrieval projects exceeding goals. This underscores the benefits of proactive planning and strong partnerships.

Looking Ahead: The Future of Healthcare Quality

The landscape of healthcare quality measurement is constantly evolving. Staying informed about upcoming changes and investing in digital transformation are key to long-term success. The increasing emphasis on data interoperability and standardized reporting will continue to shape the industry.Moreover,the focus on patient-centered care will drive demand for more obvious and meaningful quality metrics. Do you think the industry is adequately prepared for the move to fully digital reporting by 2030? How can health plans best support providers in meeting these new requirements?

Frequently Asked Questions About HEDIS & Quality Measurement