What HEDIS measures are
HEDIS stands for the Healthcare Effectiveness Data and Information Set. It is the most widely used set of standardized performance measures in U.S. health care, published and maintained by the National Committee for Quality Assurance (NCQA), a non-profit that accredits health plans. NCQA updates the measure set every year through its Committee on Performance Measurement, so the measures stay current with clinical evidence.
The scale is the point of HEDIS: because every plan calculates the same measures the same way, purchasers and consumers can compare plans on a level field. More than 90% of U.S. health plans report HEDIS, covering over 235 million enrollees.
The six domains
NCQA organizes its more than 90 measures across six domains of care: Effectiveness of Care, Access and Availability of Care, Experience of Care, Utilization and Risk-Adjusted Utilization, Health Plan Descriptive Information, and measures reported using Electronic Clinical Data Systems (ECDS). The clinical measures operators track most closely sit in Effectiveness of Care, including:
- BCS (Breast Cancer Screening) and COL (Colorectal Cancer Screening)
- CBP (Controlling High Blood Pressure)
- KED (Kidney Health Evaluation for Patients with Diabetes), EED (Eye Exam for Patients with Diabetes), and GSD (Glycemic Status Assessment for Patients with Diabetes)
- TRC (Transitions of Care) and FMC (Follow-Up after ED Visit for members with multiple high-risk chronic conditions)
The measurement year
HEDIS results are tied to a defined measurement year, the calendar year of the care being measured. NCQA names each annual specification release after its measurement year, such as HEDIS MY 2026, and plans collect data during that year and report the following year. That lag is why a gap closed in a given year may not show up in a published rating until more than a year later, and why gaps have to be managed in-year rather than chased after the scorecard lands.
HEDIS and Star Ratings
HEDIS clinical measures are a major component of CMS Medicare Star Ratings, the one-to-five-star quality score that drives Medicare Advantage quality bonus payments. Star Ratings blend HEDIS with the CAHPS member-experience survey, the Health Outcomes Survey, and CMS administrative measures. A plan's HEDIS performance moves its Star Rating and its bonus dollars, so HEDIS is an input and the Star Rating is the published composite. See cut points and triple-weighted measures for how those measures convert into stars.
The shift to ECDS, and the retirement of hybrid
The biggest change underway in HEDIS is the end of the hybrid method, which combines administrative claims with manual medical-record chart review on a sample. NCQA plans to fully phase out hybrid by measurement year 2029, with each measure moving either to administrative-only or to ECDS reporting. Under ECDS, supplemental clinical data such as labs and EHR feeds becomes the lever for getting credit on measures like KED, CBP, and GSD. Plans that have leaned on chart-chase abstraction need a different data strategy, and they need it before 2029.
How Pelica closes HEDIS gaps
Pelica's Quality and Stars copilot unifies gap lists across every payer contract into one live record, prioritizes the gaps that move the rating, and works them through to closure with voice, EMR overlays, and coordinated outreach. The platform is built for the ECDS world, ingesting supplemental clinical data rather than depending on year-end chart chase. At the largest IPA in the country, teams close roughly 90% of BCS and KED gaps in-year and 70% of transitions-of-care gaps within 30 days.
Related terms
See ECDS for the reporting standard replacing hybrid, cut points and triple-weighted measures for how HEDIS rolls into Star Ratings, and AI for HEDIS gap closure for the operating model behind closing them.