Now that HEDIS Measurement Year (MY) 2024 data collection and abstraction has wrapped, health plans are shifting toward year-round medical record review. Year-round medical record review is rapidly becoming a necessity as the National Committee for Quality Assurance (NCQA) accelerates its shift to digital quality measures. Health plans that have a strong and strategic year-round approach are seeing faster gap closure, stronger provider engagement, and improved quality ratings. Year-round medical record review allows health plans to be proactive, member-centered, and positioned for long-term success.
Here is how health plans can close out MY2024 and continue the momentum into continuous medical record review.
1. Assess HEDIS MY2024 performance
Start with what worked — and what didn’t. Before setting sights on the next cycle, it is important to evaluate what went well in HEDIS MY2024 and what could be improved. Some ways to achieve this evaluation are:
- Hold structured post-HEDIS debriefs sessions with cross-functional teams.
- Discuss areas for improvement but also share what went well.
- Utilize the feedback to develop action items for next year.
2. Make medical record review a continuous, year-round strategy
Build a strategic roadmap that supports rolling data collection, provider engagement and supplemental capture timelines. Ensure cross-functional alignment between quality, risk, provider engagement and data analytics teams.
Reviewing records throughout the year enables earlier identification of open care gaps and uncaptured conditions. It supports faster responses to emerging quality issues and increases flexibility during reporting cycles. It also improves provider engagement through continuous data exchange and feedback loops.
Healthmine’s platform helps plans support this shift with automated data pulls, configurable timelines, and real-time reporting — empowering plans to monitor more members, faster, with more measurable ROI.
3. Redesign workflows for continuous review
Shift from annual reviews to continuous workflows. Replace the year-end rush with rolling monthly reviews to reduce bottlenecks and improve data completeness. Use real-time tracking to identify care gaps, monitor member-level interventions and measure closure outcomes.
Healthmine enables this shift with integrated care gap logic, configurable review cycles and automated flagging of records through backend data feeds — allowing plans to monitor more members with less manual effort and greater real-time insight.
4. Align cross-functional teams around shared goals
Success requires tight coordination between quality, risk adjustment, analytics and data infrastructure teams — anchored by aligned priorities and shared workflows.
Healthmine’s platform makes this easier by creating visibility across teams, optimizing outreach initiatives and engagement budgets, and surfacing real-time member-level data that supports collaborative decision-making.
5. Create a focused chase strategy for diabetic retinal eye exams
With NCQA’s shift to digital measures in MY2025, capturing diabetic retinal eye exam data early is critical to avoid declines in measure performance. Review prior year chase data and HRA inputs and analyze care management records to pinpoint where members are completing their exams. Request records proactively and integrate findings into year-round review workflows to ensure timely documentation and gap closure.
Healthmine’s platform supports health plans in tracking and closing care gaps for targeted diabetic eye exams, contributing to a 15% increase in exam completion. The platform’s integrated tools facilitate proactive member engagement and streamlined record retrieval, aiding in improved Stars performance.
6. Move beyond manual medical record review
Even with a year-round approach, relying on manual review remains time consuming and costly for both plans and providers. The future lies in automation and interoperability — supporting CMS’s momentum around data transparency, electronic exchange and value-based care. Natural Language Processing (NLP) and AI tools enable faster, more accurate extraction of clinical insights from unstructured data — reducing dependency on manual processes.
Healthmine supports this shift by helping plans operationalize data through digital ingestion, member-level analytics and automated workflows that improve precision and reduce burden.
Build a digital-first strategy now for MY2025
NCQA’s digital transition is already underway. Forward-looking plans are acting now — not waiting for each mandate. A continuous, cohesive, year-round strategy helps plans stay audit-ready, adapt to NCQA’s evolving standards, and build scalable, future-proof processes.
Healthmine’s experts can help your plan move from manual chart review to a streamlined digital quality roadmap that closes more gaps, reaches more members and improves outcomes.
Let’s build a more cohesive, data-driven strategy — together.
Contact our expert advisory team to assess your current strategy and explore a digital roadmap to guide your plan through the transition from manual year-round chart review to a robust digital-first approach for 2025 and beyond.
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