A Real-World Approach to Digital Quality: Healthfirst’s Phased Journey
April 7, 2026 | CQL and FHIR, Digital Quality Measures (DQM), Digital Quality Transformation, Quality Improvement, Star Ratings, Uncategorized, Year Round Prospective HEDIS®
Twenty Questions Your HEDIS Vendor Doesn’t Want You to Ask about Digital Quality
The 2030 NCQA deadline for fully digital HEDIS reporting is closer than it looks – and the gap between “our vendor has a roadmap” and “our vendor has a product” is wider than most health plans realize.
Rebecca Jacobson, MD, MS, FACMI
Co-Founder, CEO, and President
Incumbent HEDIS engine vendors are telling health plans not to worry about digital quality – even though they have no product, no process, and no price to show for it. That’s a comfortable message to deliver — and a dangerous one to believe. The stakes are real: plans that move early on digital quality measurement (dQM) stand to gain a meaningful head start on benchmarking, data readiness, and operational efficiency. Plans that wait may find themselves scrambling through expensive chaos under a looming deadline.
The harder truth is that legacy vendors will likely attempt to retrofit digital methods onto their existing systems rather than rebuild natively – and that approach forfeits many of the core benefits of digital quality: rapid measure deployment, standardized FHIR data, and the ability to run measures daily.
Your team needs to know what to ask. Here are twenty questions that get to the heart of what matters:
Product Readiness and Timeline
1. Do you have a production-ready digital HEDIS engine today, or is it still on your roadmap?
Distinguish between marketing materials and an actual, deployed, customer-tested product.
2. What is your committed roadmap and delivery timeline for a validated/certified digital HEDIS engine?
Ask for specific milestones tied to validation of MY2025, MY2026, and the ~2030 NCQA full-transition deadline.
3. How will you meet the ~2030 NCQA deadline for full digital HEDIS reporting?
How will you help plans support the process of mapping and benchmarking now to achieve sufficient parity with traditional measures?
4. Are you building a native FHIR/CQL engine, or retrofitting your existing legacy engine?
Retrofitted legacy engines are unlikely to deliver the key benefits of digital quality (e.g., rapid measure deployment, standard-based inputs, daily runs). What is your plan for supporting a native FHIR/CQL engine?
NCQA Measure Validation (formerly known as “Measure Certification”)
5. Is your engine NCQA-validated for any digital (FHIR/CQL) measures? Which ones and for which measurement year?
NCQA certification is a prerequisite for reporting. Confirm whether their certification covers all measures for the current MY2025.
6. When do you expect to make the new measurement year’s validated digital measures available to customers?
Traditional HEDIS engines often make customers wait until fall of the measurement year due to implementation of the traditional (paper) specification. In contrast, digital measures can be made available almost immediately after the release of the code by NCQA. Ask for a concrete availability date.
7. Is your engine capable of running NCQA-published CQL measure packages directly, without internal recoding?
Engines that require internal recoding of the NCQA distributed CQL measures introduce delays and risk of implementation errors. Native CQL execution means measures are available as close to NCQA’s publication date as possible, and that validation should be fast and easy.
Data and FHIR Mapping
8. What is your plan for mapping all required data sources to FHIR in compliance with the NCQA FHIR Implementation Guide (IG)?
Data mapping is the most effort-intensive phase of digital transition and needs to be validated iteratively by running data through measures. Ask for a detailed understanding of the process, responsibilities, and timeline for achieving the required mapping and benchmarking.
9. How will you validate the quality and completeness of the FHIR data mapping?
Proper validation requires running mapped data through live measures to verify output, not just a one-time schema check. Vendors should have appropriate validation support within their platforms.
10. What data ingestion formats do you support (FHIR API, FHIR bundles, flat files, CCD)?
Health plans are at varying stages of data maturity; vendors need to meet the health plans where they are and support future interoperability FHIR APIs.
11. What data validation and error visibility do you provide during ingestion?
Plans need to inspect and troubleshoot errors at the FHIR resource level to maintain audit-defensible data quality.
12. Will the vendor process allow us to retain data in the FHIR format?
A major advantage of the standardized FHIR format aligned to the HEDIS Implementation Guide is that you will be able to use the identical data inputs with any native CQL HEDIS engine. Will your vendor allow you to retain this data? Will you in effect “own” these mappings from your data to the standard?
Scalability and Performance
13. Has your digital engine been tested at production scale for large health plans? What are the results?
Scaling is a known challenge. Plans should specifically request run-time results showing the scale at which the engine has already been tested. Additionally, vendors should provide detailed descriptions of HOW they evaluate scale, including how they ensure that testing data replicates real-world data and conditions.
14. How frequently can you run digital measures — monthly, weekly, daily?
A key benefit of native digital quality engines is the ability to run measures far more frequently than annual or bimonthly cycles.
Reporting, Operations, and Flexibility
15. Can you generate the required reporting outputs: IDSS files, Medicare PLD files, Medicaid member-level detail files, from digital measure runs?
Reporting outputs are distinct from raw measure results and are required for official HEDIS submission.
16. Can we run state measures, Core measures and custom measures in the same engine?
Many health plans need to run measures beyond standard HEDIS. Confirm that the platform supports state, CMS core, and custom VBC measure execution. What is the vendor roadmap and plan to support these measure sets?
17. Can we write and execute our own custom measures based on the FHIR IG?
Another advantage of the digital standard is that it enables plans to create their own custom measures. Confirm that your staff will be able to use the engine for this purpose.
18. Do you provide member-level result explainability to tell you why a member was included/excluded, why a gap wasn’t closed?
Audit-defensible quality reporting requires drill-down to the member level and the ability to trace results to specific data elements.
19. What is your support model and SLA for troubleshooting during the measurement year?
Digital transitions involve new failure modes. Confirm escalation paths, response times, and technical depth of support, including specific expertise in trouble shooting digital measures.
20. Do you have existing customers in production with your digital HEDIS engine today? Can we speak with them?
Ask for customer references who are live on the digital engine and not just pilot or POC customers.
Astrata built our eMeasure solution from the ground up as a native FHIR/CQL digital quality engine – no legacy retrofit and no workarounds. We think our answers to these twenty questions will speak for themselves.