Best HEDIS and Stars software for quality teams in 2026.

Why the criteria changed

NCQA is retiring the hybrid HEDIS method, which let plans report a measure off a small chart sample, and moving measures to ECDS reporting, Electronic Clinical Data Systems, with the transition completing by HEDIS reporting year 2029. That single change resets what "good" means for HEDIS and Stars software. A tool tuned for end-of-year chart chasing on a sample is solving last decade's problem.

Under ECDS, a plan needs continuous electronic clinical data for the full eligible population rather than a sampled subset. In practice that can mean roughly 35x to 75x more supplemental data per measure, because every eligible member now needs a captured, structured result instead of a chart review on a fraction of them. The teams that do well are the ones that keep electronic data flowing year round and act on open gaps as they appear, not the ones that staff up a chart-chase sprint each spring. For the mechanics of the shift, see our ECDS transition guide.

Two dates, not one

Most vendor pages tell half of this story. The hybrid method goes away by measurement year 2029. NCQA's stated goal is fully digital HEDIS by measurement year 2030, which is the larger change. A digital quality measure, or dQM, ships as a self-contained package with computable specifications in HL7 FHIR and CQL instead of a PDF spec that every vendor reads and codes on its own (NCQA: the digital quality transition). If a vendor only talks about 2029, ask what its plan is for 2030.

NCQA has published the schedule measure by measure. Lead Screening in Children becomes administrative only in MY 2026, and Weight Assessment and Counseling for Children and Adolescents follows in MY 2027. In MY 2028, Prenatal and Postpartum Care goes administrative only while Controlling High Blood Pressure and Blood Pressure Control for Patients with Diabetes move to ECDS. Glycemic Status Assessment, Transitions of Care, and Care for Older Adults move to ECDS in MY 2029 (NCQA: proposed timeline for retiring hybrid measures).

What the CY2027 final rule changed

CMS published the CY2027 Medicare Advantage and Part D final rule on April 6, 2026. It removes 11 measures from Star Ratings calculations beginning with the 2027 measurement period, does not finalize the proposed removal of the Diabetes Care Eye Exam measure, adds a depression screening and follow-up measure that applies from the 2027 measurement year and first shows up in the 2029 Star Ratings, and keeps the longstanding reward factor instead of the Health Equity Index. A shorter measure set means each measure that survives carries more of the rating, so each gap you close on a survivor is worth more than it was last year.

How to choose

1. ECDS readiness

Ask how the tool ingests and reconciles supplemental electronic data: lab results, immunization registries, EHR feeds, HIE data. A tool that can stand up standard supplemental data feeds and map them to ECDS-eligible measures is ready. A tool that still depends on pulling and abstracting charts at year end is not. The volume of data required under ECDS is the part most teams underestimate.

2. Reports gaps or closes them

This is the dividing line. Most tools report: they calculate rates, surface open numerators, and render dashboards. Closing the gap is a different job, reaching the member, booking the visit, capturing the result, and feeding it back as ECDS-eligible data. A useful test: ask what happens after a gap is identified. If the answer ends at "it appears on a worklist," that is reporting. If the platform places the outreach and updates the record, that is closing.

3. Coverage across payer contracts

Quality teams often run a separate gap list per payer, which fragments the work and produces duplicate outreach to the same member. A single canonical record per member, with each contract's measure logic applied against it, lets one team close gaps once across every contract and forecast each contract's Stars glide path. The trade-off is depth in one program versus coordination across all of them.

4. Audit and certification posture

For payer-grade reporting you still need NCQA-certified measure calculation and a defensible audit trail, especially during the years when hybrid and ECDS measures coexist. Confirm certified measure logic, a signed Business Associate Agreement, and full audit trails on any automated action.

Two specialists are worth knowing if the digital transition is the part that worries you. Astrata, working with Smile CDR, built one of the first NCQA-certified digital HEDIS engines on FHIR and CQL. Cozeva, part of Vatica Health since the two merged on October 31, 2025, markets native-FHIR certified measure engines. Neither is a full quality suite, and that is the point of naming them.

Vendor comparison

The table groups representative vendors by what they are built to do. Categories are descriptive, not pejorative: a strong abstraction engine and a strong execution layer solve different problems, and many teams run more than one.

The certification column comes from one checkable source. NCQA publishes a HEDIS and AMP measure certification status list for vendors, and the version below was last updated on July 23, 2026 (NCQA MY2026 measure certification vendor list). Treat it as a snapshot of what NCQA has processed, not a scoreboard. Inovalon announced MY2026 certification on the same day that list was updated and still shows as seeking on it, and a vendor that is absent may simply integrate with someone else's certified engine.

Reveleer

Reveleer built its business on high-volume retrospective work: automated chart retrieval, record parsing, and abstraction fields populated for human review, alongside RADV and IVA submissions. Describing it as retrospective-only stopped being accurate some time ago. It acquired Curation Health in October 2024 for prospective, point-of-care rules and EHR integrations, and Novillus in April 2025 for care gap management and provider engagement. In January 2026 it launched EVE Hybrid AI for prospective diagnosis suspecting, and in April 2026 a Clinical Data Repository the company describes as a unified, AI-enriched member-level clinical record spanning risk, quality, RADV, and care management. For a quality team running large chart-review and audit-submission programs, Reveleer is a strong fit. The line between us now is the action layer and the shared outreach queue. Which direction the data flows stopped being the difference.

Cotiviti

Cotiviti is a payer-grade analytics and quality company with deep roots in data and payment integrity. Its Quality Intelligence engine was certified in June 2026 for all available NCQA digital HEDIS measures for measurement year 2025, and the company completed its acquisition of Edifecs on March 31, 2025, adding an interoperability business that took 2026 Best in KLAS for CMS Payer Interoperability at 91.9. Ric Sinclair became CEO effective March 16, 2026. For a health plan that needs audit-grade, certified measurement at scale, Cotiviti is a serious enterprise choice. It also ships member outreach now through Engagement Hub, launched January 14, 2025, with Eliza delivering outreach to more than 50 million members. The distinction that still matters is between campaign outreach to a member list and a worked queue with escalation and evidence written back at the moment of the action.

Inovalon

Inovalon pairs a certified measure engine with a large connected data network and cloud analytics for quality and risk. It took 2026 Best in KLAS in Quality Measurement and Reporting for payers (announced February 4, 2026), and on July 23, 2026 announced its 26th consecutive NCQA HEDIS measure certification for Converged Quality plus NCQA validation of its measure engine for digital quality measures, stating it is one of only three vendors at 100% validation coverage. It announced an Integrated Care Gap Closure solution on October 31, 2025. For plans that want measurement and insight drawn from a broad national data set, Inovalon is well established, and the reach-the-member step still sits with the plan's own teams.

Arcadia

Arcadia is a data-platform and analytics company built on a healthcare data lakehouse that curates EHR, claims, pharmacy, and ADT data into a longitudinal record. That foundation is useful for ECDS because continuous electronic data is what the method requires, and Arcadia holds NCQA Data Aggregator Validation Certified Data Partner designation, earned July 31, 2024. Nordic Capital acquired a majority stake on July 2, 2025. Arcadia is a good fit when the priority is a clean, queryable data foundation across a large population. Its center of gravity is insight rather than executing the outreach itself.

Innovaccer

Innovaccer is the vendor most likely to sit next to everyone above on a shortlist. Its InGraph engine appears on NCQA's list as certified for all HEDIS Health Plan measures for MY2026, and Galaxy took 2026 Best in KLAS in Data Analytics Platform for Payers at 90.5 against a category average of 87.2, announced February 4, 2026. It has also owned Pharmacy Quality Solutions, which operates the EQuIPP platform most plans use to measure PDC, since March 2024. In July 2026 the company published its own six-platform HEDIS comparison arguing that one data model across risk and quality is what closes gaps.

How to read the unified-platform argument

The argument holds up as far as it goes, and we make part of it ourselves. One data model across risk and quality means a plan does not retrieve and pay for the same chart twice, which is the same reason we build one canonical record per member. FHIR-native storage is worth having before 2030, because that is the form the dQM specifications arrive in.

What it leaves out is who performs the action. A unified model can tell you a member is open on colorectal screening across three payer contracts. It does not call her, find a Saturday appointment near her, and get the result back on the record as ECDS-eligible evidence. Four questions separate the two claims, and they work on any vendor, including us:

• Who operates the channel. Listing provider offices, pharmacies, and member outreach as gap-closure channels describes where work can happen. Ask who dials: your staff, or the software.
• Time from event to first contact. Ask for the number in hours. ADT-triggered outreach latency is measurable, and buyers almost never ask for it.
• Where the evidence lands. The result has to write back into the system of record at the moment of the action, not get reconstructed from a chart the following spring.
• One queue or many. Cross-payer gap consolidation means the same member appears once across every contract and every program, so quality, pharmacy, and care management are not each calling her in the same week.

FHIR-native describes how a measure is stored and computed. It is not a claim about whether the member picked up the phone, and the two get argued as if they were the same thing.

Where an AI execution layer fits

The vendors above are strong at what they were built for, and most quality teams need certified measurement and a solid data foundation. The gap they feel is not a missing dashboard. Under ECDS, knowing the gap and closing the gap are two different jobs, and the second is where staff time disappears, especially when the same member sits open on three payers' lists at once.

Pelica is the execution layer. One canonical record per member, built from claims, EHR, pharmacy, lab, ADT, and payer feeds, sits under a Quality & Stars copilot that applies every payer contract's measure logic against one record. On top of it is an action layer: outbound voice, EMR overlays, and a provider portal that reach the member, book the visit, and capture the result as ECDS-eligible data. The copilot forecasts each contract's Stars glide path so teams see, before the year closes, which measures will land and where to push. The point is not to show the work. It is to do it.

At our flagship customer, a physician-led IPA in New York running risk on roughly 200,000 patients, the platform reached 100% team adoption and 96% adherence on the three triple-weighted Part D measures. Across deployments, customers have seen a 41% gap-closure improvement and 3x outreach capacity per coordinator without adding headcount. That is the trade most quality teams are weighing as ECDS lands: another reporting tool, or a layer that closes the gaps the reports surface.

Under ECDS, the report is no longer the deliverable. The closed gap is.

None of this makes analytics and abstraction platforms wrong. If you have no certified measurement or no clean data foundation, you may need one first. But if your team already knows which gaps are open and the work is not getting done at volume, an execution layer is the purchase that moves the rate, and it deploys in weeks rather than quarters.

If your remit runs past HEDIS and Stars into risk, pharmacy, and care management, the same one-record question applies across all of them. Our guide to the best value-based care software compares the platforms that unify those programs, and for the Part D side specifically, see the best Part D adherence software.

Sources

• NCQA: HEDIS measures and the ECDS reporting transition
• NCQA: HEDIS and AMP MY2026 measure certification vendor list (last updated July 23, 2026)
• NCQA: the digital quality transition, FHIR and CQL
• NCQA: proposed timeline for retiring and replacing HEDIS hybrid measures
• Federal Register: CY2027 Medicare Advantage and Part D final rule (April 6, 2026)
• CMS: Medicare Advantage rates, statistics, and risk adjustment
• Inovalon: 26th consecutive NCQA HEDIS certification and dQM engine validation (July 23, 2026)
• Innovaccer: 2026 Best in KLAS results
• Reveleer: Clinical Data Repository (April 7, 2026)
• Cotiviti: completion of the Edifecs acquisition (March 31, 2025)