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.
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.
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.
| Vendor | Category | ECDS-ready | Reports or closes gaps | Typical deploy | Best-fit org |
|---|---|---|---|---|---|
| Reveleer | Retrospective chart review and HEDIS abstraction; RADV and IVA support | Moving toward it | Reports (abstracts and validates) | Weeks to months | Plans running scaled chart review and audit submission |
| Cotiviti | Payer quality analytics and certified HEDIS measurement; data and payment integrity heritage | Yes | Reports (measures and analytics) | Enterprise, multi-quarter | Health plans needing certified, audit-grade measurement at scale |
| Inovalon | Cloud quality and risk analytics with a large connected data network; certified measure engine | Yes | Reports (analytics and measurement) | Enterprise, multi-quarter | Plans wanting analytics on a broad national data network |
| Arcadia | Healthcare data lakehouse and analytics at scale; longitudinal record across EHR, claims, ADT | Strong data foundation | Reports (data and analytics) | Enterprise, multi-quarter | Systems and ACOs wanting a clean longitudinal data foundation |
| Pelica | Execution layer: one canonical record plus a Quality & Stars copilot and an action layer | Yes, built for it | Closes gaps across every payer contract | 2 to 4 weeks to a live copilot | Risk-bearing IPAs, ACOs, and plans that need the work done, not just reported |
Reveleer
Reveleer's core strength is high-volume retrospective work. It automates chart retrieval, parses records, and populates abstraction fields for review, supporting HEDIS abstraction alongside RADV and IVA submissions. For a quality team that needs to run large chart-review and audit-submission programs accurately and on time, Reveleer is a strong fit. Its center of gravity is extracting and validating data that has already arrived, which is the work the ECDS transition is designed to shrink over time.
Cotiviti
Cotiviti is a payer-grade analytics and quality company with deep roots in data and payment integrity. Its quality offering covers certified HEDIS measurement and the analytics plans rely on for regulatory reporting. For a health plan that needs audit-grade, certified measurement at scale across a large membership, Cotiviti is a serious enterprise choice. Its strength is measuring and analyzing performance rather than executing the member-level outreach that closes an open gap.
Inovalon
Inovalon pairs a certified measure engine with a large connected data network and cloud analytics for quality and risk. For plans that want measurement and insight drawn from a broad national data set, Inovalon is well established. As with other analytics platforms, its design point is computing and surfacing the gap. The act of reaching the member and capturing the result 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 exactly what the new method requires. Arcadia is a good fit when the priority is a clean, queryable data foundation and analytics across a large population. Its center of gravity is insight rather than executing the outreach itself.
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 175,000 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.