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Case Study & ROI Analysis

Capital District Physicians’ Health Plan, Inc. (CDPHP®) 2025 Case Study: Increasing HEDIS Rates with an NLP-Driven Prospective Review Process

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Astrata has been named a recipient of the 2025 Points of Light Award from KLAS’ K2 Collaborative, in partnership with Capital District Physicians’ Health Plan, Inc. (CDPHP®) for increasing Healthcare Effectiveness Data and Information Set (HEDIS) Rates with Natural Language Processing (NLP)-Driven Prospective Review Process.

 

The Points of Light Award celebrates the partnership success stories—or Points of Light—from payers, providers and healthcare technology companies that work collaboratively to reduce inefficiencies and improve the patient, provider, and payer experience. To be considered for a Point of Light Award, organizations must submit their case study for consideration.

“Receiving the KLAS Points of Light Award affirms the importance of innovation in how we close care gaps. As the industry moves toward digital quality measurement, Astrata’s solution proves it’s possible to gain deeper clinical insights without adding to provider burden—an essential step forward for value-based care.”

Rebecca Jacobson, CEO, President and Co-Founder, Astrata

Astrata offers a proven, HITRUST-certified solution to impact payers’ quality reporting, reduce provider abrasion and improve patient care and outcomes. This acknowledgment from KLAS is a testament to the value that Astrata is delivering to healthcare quality as it continues to focus on accelerating value-based care.

In the Points of Light 2025 Case Study 14: Increasing HEDIS Rates with an NLP-Driven Prospective Review Process, the goal was to improve the accuracy of HEDIS reporting as well as the HEDIS quality rates for key populations. Astrata partnered with Community Care Physicians and CDPHP to implement a broad HEDIS workflow using NLP. Standard industry practices rely primarily on claims data to close HEDIS gaps. However, because clinicians often use free-text clinical notes to document compliance, structured claims data alone does not provide a complete picture of a member population’s compliance with Medicaid measures. As the National Committee for Quality Assurance (NCQA) retires the hybrid methodology, payer and provider organizations are at risk of significantly underestimating their HEDIS compliance

Points of Light -First Year Outcomes Achieved Through Collaboration for the entire project:

  • Over a short period of time (66 days of abstraction), HEDIS rates increased from the base level for all six measures studied: These measures are COL (Colorectal Cancer Screening), CCS (Cervical Cancer Screening), BCS (Breast Cancer Screening), WCC-Nut (Well Child Nutrition), WCC-PA (Well Child Physical Activity), and WCC-BMI (Well Child Body-Mass Index).
  • Increased the speed of prospective HEDIS reviews by 500% when using the software as compared to abstraction without the software.
  • Astrata software showed the highest specificity when compared to three other alternative data sources.
  • Accuracy of Chart Review NLP in triaging cases for abstractors was 96.8% across all measures.
  • Reduced payer-provider administrative abrasion.

Astrata, CDPHP and Community Care Physicians are continuing to look for opportunities to use technology to improve efficiencies.

“Through our collaboration with Community Care Physicians and Astrata, CDPHP has witnessed firsthand the powerful impact that the right data and technology can have in reducing administrative burden for our physicians while enhancing quality of care,” said Mike Farina, VP, Healthcare Quality, CDPHP. “With real-time clinical information available at the point of care, we’re much better equipped to work together to deliver optimal health outcomes and support the overall well-being of our community.”

“This partnership gave our providers tools that fit seamlessly into their workflow. This is helping us close care gaps faster while reducing administrative burden. We’re proud to be part of an initiative that puts data to work in a way that’s both practical for clinicians and meaningful for patients.”

Ellen Guerin, Manager Clinical Quality Initiatives, Community Care Physicians

Astrata being in a recognized partnership and winning a 2025 Points of Light Award from KLAS’ K2 Collaborative, highlights the transformative potential of collaboration. Working together, new technology can produce powerful impacts on operations and outcomes. But those impacts are multiplied when stakeholders are aligned across payers, providers and vendors.

About KLAS

KLAS is a data-driven company on a mission to improve the world’s healthcare by enabling provider and payer voices to be heard and counted. Working with thousands of healthcare professionals, KLAS collects insights on software, services, and medical equipment to deliver reports, trending data, and statistical overviews. KLAS data is accurate, honest, and impartial. The research directly reflects the voice of healthcare professionals and acts as a catalyst for improving vendor performance. Learn more at KLASresearch.com.

About Astrata

Astrata (www.astrata.co) is a digital quality company, offering a suite of products and services for health plans and value-driven providers who are moving from paper-based clinical quality measures to digital clinical quality measures, as required by NCQA and CMS. Astrata’s products make it possible to better measure and improve healthcare quality, a foundation for moving to value-based care. Astrata’s value propositions include dramatic efficiency gains, higher clinical quality rates, and increased quality bonus payments.

Points of Light 2025 Case Study 14

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