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Compliance & Quality

HEDIS Solutions

HEDIS gap closure, chart abstraction, medical record retrieval, and quality analytics — better scores, better outcomes, and stronger positioning with every health plan you contract with.

Quality operations

Gap closure you can watch, season you never feel

HEDIS QUALITY DASHBOARD · SAMPLE DATA

LIVE

Measure performance · gap closure YTD (ticks = 75th percentile)

Breast cancer screening (BCS-E)82%
Colorectal screening (COL-E)76%
HbA1c control (GSD)88%
Childhood immunizations (CIS-E)91%
Well-child visits (WCV)79%

WCV trailing the 75th percentile — recall campaign generated 214 outreach calls this month; 68 visits scheduled.

Season operations

1,240

care gaps closed YTD

96%

abstraction inter-rater reliability

8,400

charts retrieved this season

90+

measures supported

▲ AI GAP FINDER — 37 patients due for colorectal screening also have visits scheduled within 30 days · flags pushed to point-of-care worklists

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Business outcomes

What this changes for your organization

HEDIS Solutions · performance standards

measured continuously

HEDIS measures supported across domains

90+

abstraction and retrieval capacity

Season-scale

reporting for value-based contracts

VBC-ready

Performance standards we operate to. Actual results vary by specialty, payer mix, and starting position — your free assessment establishes your own baseline.

Care gaps closed before season

Patient-level worklists and recall programs close screening and preventive gaps during the year — when they still count, for the patient and the score.

Abstraction at any scale

Certified abstractors with measure-specific QA overreads absorb measurement season entirely — your staff never touches a chart pull.

Scores you can watch move

Measure-level dashboards track gap closure and projected rates continuously — quality management becomes an operating rhythm, not an annual audit.

Stronger position with every plan

Demonstrable quality performance strengthens contract negotiations, tier placement, and incentive capture across your entire payer mix.

The stakes

The problem, in numbers

The honest diagnosis — what this challenge actually costs healthcare organizations that leave it unmanaged.

Invisible

care is uncounted care — and uncounted care scores zero

The screening happened, the vaccine was given, the follow-up occurred — but if it isn't captured, coded, and retrievable, HEDIS says it didn't happen. Scores measure documentation as much as care.

$ tiers

quality scores now decide network tiers and bonus dollars

Health plans use HEDIS-derived measures for star ratings, pay-for-performance, and value-based terms. Weak scores mean weaker contracts — regardless of clinical reality.

Season

measurement season overwhelms every in-house team

Chart requests, abstraction deadlines, and record retrieval land all at once, every year — precisely when your staff has a full schedule of patients to serve.

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Our solution

HEDIS scores decide how health plans see you: they drive star ratings, pay-for-performance bonuses, network tiering, and value-based contract terms. For providers, the frustrating part is that the care usually happened — it just wasn't captured, coded, or retrievable when the plan came looking.

Our HEDIS team closes that gap in both directions. For providers: care-gap identification and outreach workflows, preventive care monitoring, and documentation patterns that make compliant care visible in claims and charts. For health plans and larger organizations: chart abstraction, medical record retrieval, and population health analytics at measurement-season scale. The result is quality scores that reflect the care you actually deliver — and reimbursement that follows.

What's included

  • Care-gap identification with patient-level worklists
  • HEDIS chart abstraction by certified abstractors
  • Medical record retrieval and secure delivery
  • Preventive care and screening recall programs
  • Risk adjustment and HCC recapture support
  • Quality dashboards with measure-level tracking

In the field

How organizations like yours use it

USE CASE 01

A primary care network lifted breast cancer screening 18 points

Gap identification plus a recall program ran January through October instead of a December scramble — the measure moved from below the 25th percentile to above the 75th in one measurement year.

USE CASE 02

A health plan cleared 40,000 charts in one season

Retrieval, abstraction, and QA overreads delivered at measurement-season scale with 96% inter-rater reliability — the plan's internal team focused on analysis instead of collection.

USE CASE 03

An ACO-bound group built its quality baseline in six months

Before signing value-based terms, the group needed to know its real performance. Measure-level baselining revealed strengths worth negotiating on — and two gaps worth fixing first.

Scenarios drawn from typical engagement patterns; identifying details anonymized to protect client confidentiality.

Common questions

HEDIS Solutions, answered

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