Digital HEDIS: Buy vs. Build vs. Wait

Wait: The Hidden Risk of Standing Still 

The most common pitch health plans are hearing from incumbent vendors sounds something like this: “We’ll have a digital HEDIS product ready in time, and we’ll manage the transition for you.” It’s a comfortable message — and a potentially costly one. 

Most incumbents are building retrofitted HEDIS engines — adapting traditional measure logic to accept digital inputs, or bolting digital reporting onto an existing traditional core. They are not building purpose-built digital solutions. The difference matters enormously: 

• Daily and weekly runs remain a challenge. One of the most significant advantages of a true digital engine is the ability to run measures continuously for real-time care gap management. Retrofitted engines struggle to deliver this. 

• Cost savings don’t materialize. Digital HEDIS should be less expensive than traditional HEDIS over time. A retrofitted engine carries the overhead of its traditional architecture and is unlikely to deliver those savings. 

• Measure updates lag behind. Natively digital engines can release updated measures much more quickly following NCQA publication. Retrofitted solutions will lag behind, using the same timelines that the current traditional engines use. 

• You stay locked into a proprietary format. With a retrofitted engine, your data pipelines remain tied to a vendor-specific format. You lose the interoperability benefits that FHIR was designed to provide: portability, vendor neutrality, and the ability to reuse data investments across systems. 

Perhaps most critically: delaying your data mapping and benchmarking by another year or two puts you in a dangerous position heading into 2030. The plans that wait will be rushing their transitions while competing for the same scarce implementation resources. Rate impacts from a poorly executed switch could be substantial and lasting. Waiting offers one genuine benefit — no immediate investment or effort. But that calculus changes quickly as the deadline approaches. 

Build: Bare-Bones Tech Isn’t Enough 

Some health plans are pursuing a “build” path by purchasing foundational CQL technology components from a technology vendor and assembling the rest themselves. On paper, this offers flexibility and control. In practice, it often underestimates what it actually takes to achieve comparable HEDIS rates with the new NCQA HEDIS FHIR standard — and plans that go this route may find themselves with a capable engine but no one to drive it. 

The core challenges: 

• Data mapping expertise is the real bottleneck. The single most important factor in achieving strong HEDIS rates with digital technology is the ability to accurately map your plan’s data to the NCQA standard. This requires deep subject matter expertise and knowledge of the NCQA FHIR IG that is currently very scarce in the market. A technology component won’t supply it. Without that expertise in-house, your rates are at risk regardless of how sophisticated your technical stack is. 

• You may end up buying twice. Plans that purchase component technology today often discover they still need a full end-to-end solution as the 2030 deadline approaches. That means a second procurement, a second implementation, and a compressed timeline — exactly the scenario you were trying to avoid. 

For plans with robust internal data engineering teams and existing HEDIS subject matter experts, a build approach may be viable. For most, it trades one set of risks for another. 

Buy: A Better Product at a Better Price 

A purpose-built digital HEDIS solution offers the most direct path to a successful transition — if you choose the right partner. When evaluating vendors, look for: 

• End-to-end capability — from data ingestion and normalization through measure execution, results investigation and reporting, without gaps that require internal workarounds. 

• Proven MY25 validation with a clear plan for MY26 NCQA measure validation. 

• A roadmap for State, Core, and Custom measures — not just a subset of commercial HEDIS. 

The honest challenge: the digital HEDIS vendor market is still maturing. There are still few fully proven solutions available, and buying early means accepting some risk. 

When evaluating technology vendors, be sure that their CQL engines are validated against this year’s measures. Refer to this blog for a list of key questions to ask any HEDIS vendor when assessing your options and implementation strategies. 

Astrata was built for exactly this moment. We offer a true end-to-end digital HEDIS engine, designed to scale to very large populations, and we are already developing State and CMS Core measures with a roadmap for much more. We also recognize that health plans shouldn’t have to purchase a second full digital engine to get started — our phased implementation model allows plans to begin their transition at a lower initial cost, reducing risk while building toward full digital capability. 

The Bottom Line

The Buy vs. Build vs. Wait decision is a genuine strategic choice. Plans that move thoughtfully now, with the right partners and the right data foundation, will be well positioned as digital HEDIS matures. Plans that wait risk finding themselves behind at exactly the moment it becomes costly to catch up.

Ready to explore what a phased digital HEDIS transition could look like for your plan? Reach out to the Astrata team here.