Agenda

Join a panel of policy experts as they connect changes from CMS's CY2027 final rule, as it relates to Star Ratings, combined with the changes of NCQA's MY 2027 release, to operational and financial reality.

• Recalculate your weighted measure portfolio under the leaner set and pinpoint the two or three measures now carrying disproportionate rating leverage
• Model how cut points are likely to move as removals reshape the field, and where new or restructured measures leave you without a reliable baseline
• Stress-test your path to the next threshold: which measures, at what rate of improvement, by which measurement year, and where marginal dollars stop buying rating movement

• Understand exactly where member experience still moves your Star Ratings (and your revenue) now that administrative measures are gone and weighting has been recalibrated under the CY2027 final rule
• Identify which CAHPS survey items respond best to plan intervention, and where your experience investment delivers measurable ratings return
• Discover how HEDIS® data can predict and improve CAHPS results, from using gap-closure outreach as an experience touchpoint to spotting access problems before they show up in survey scores

• Examine how health equity factors show up in your HEDIS® data, with case study insights into gap closure for specific populations
• Take an expert-led deep dive into two measures where disparities weigh heaviest: Depression Screening and Follow-Up (DSF-E), which begins counting toward Star Ratings in the 2027 measurement year, and Glycemic Status Assessment (GSD/hemoglobin A1c)
• Learn how to balance performance across subpopulations with targeted interventions that close equity gaps and raise your overall depression screening and glycemic control rates at the same time

Participate in a facilitated roundtable discussion and deep dive with peers on timely topics: 

1. Small Plan Idea Exchange – Working with Constrained Resources
2. Double Duty or Divide & Conquer? The HEDIS® + Risk Adjustment Chart Review Debate
3. Getting Providers to Share: VBC Contracts and Incentives for Digital Data Exchange
4. FHIR and Bulk Data: Where Is Everyone, Really?
5. The HEDIS® Workforce of 2030: Reskilling Abstractors and Building the New Quality Team
6. Members Who Don't Pick Up: Outreach Fatigue and Engaging the Hard-to-Reach
7. One Team, Many Report Cards: Managing HEDIS® Across Multiple Lines of Business

Plans share what actually worked (and didn’t): NLP and agentic AI for chart review and abstraction, supplemental-data validation, member outreach targeting.

HEDIS and risk adjustment chase many of the same charts on separate timelines, through separate vendors, often asking the same provider for the same record twice. One health plan spent years building the alternative: a single centralized repository both teams retrieve from and work in. Hear what it took to build, fund and adopt — including the parts still in progress.

• Understand how one repository serves two retrieval calendars, two sets of documentation standards and two audit trails without either team losing what it needs
• Learn how the project cleared its internal hurdles: the joint business case, settling ownership and budget between quality and risk adjustment, and bringing IT, compliance and vendor partners along over a multi-year build
• Get a candid progress report — duplicate requests, abstraction and coding efficiency, provider abrasion — plus what the team would do differently and what a plan needs in place before attempting this

Work Groups: HEDIS, Measure-by-Measure

This interactive session is designed to facilitate constructive dialogue regarding specific HEDIS measures. Participants will engage in deep, collaborative discussions to identify barriers, share strategies, lessons learned, and best practices, and explore innovative solutions to improve performance on these measures.

Round 1 Measures:

1. Controlling High Blood Pressure (CBP)
2. Depression Screening and Follow-Up (DSF-E)
3. Colorectal Cancer Screening + Follow-Up After Positive Non-Invasive Test (COL-E/COF-E)
4. Kidney Health Evaluation for Patients With Diabetes (KED)
5. Transitions of Care (TRC)
6. Medication Adherence (Part D: Diabetes, Hypertension, Cholesterol)
7. Osteoporosis Management in Women (OMW)
8. Follow-Up After ED Visit for People With Multiple High-Risk Chronic Conditions (FMC)

Round 2 Measures:

1. Glycemic Status Assessment for Patients With Diabetes (GSD)
2. Eye Exam for Patients With Diabetes (EED)
3. Care for Older Adults (COA)
4. Plan All-Cause Readmissions (PCR)
5. Blood Pressure Control for Patients With Diabetes (BPD)
6. Adult Immunization Status (AIS-E)
7. Controlling High Blood Pressure (CBP) (encore)
8. Depression Screening and Follow-Up (DSF-E) (encore)