Post CMS Stars April 30, 2025 Bridge the gap: How health plans can modernize data pipelines for digital CMS Stars programs Digital Quality Measures (dQMs) are coming fast—but most health plan IT teams still live in a hybrid world. You’re responsible for supporting current HEDIS® and CMS Stars engines while preparing for FHIR®, CQL, and the next generation of measurement. This doesn’t have to be an either/or problem. With CareEvolution®, IT teams can clean and enrich existing data pipelines to boost current Stars performance—and build the foundation for a scalable, standards-based digital quality future. The challenge: Dirty data, disconnected systems, and digital pressure Legacy quality programs often rely on fragmented data, patchwork ingestion, and extensive manual abstraction. This leads to: Gaps in care that don’t close fast enough Poor data quality feeding CMS Stars engines Inaccurate or incomplete HEDIS submissions Limited visibility for clinical or member outreach teams Paralysis around when and how to start adopting dQMs You need a way to improve today’s data and prepare for tomorrow’s standards—without overhauling everything at once. The CareEvolution approach: Clean, enrich, and enable CareEvolution helps IT teams modernize quality infrastructure by providing a platform that can run in parallel with existing programs. It lets you clean and enrich the data you already have—while enabling a standards-based architecture for digital quality measures. Ingest and aggregate legacy & digital data CareEvolution’s ingestion engine can process: HL7v2, C-CDA, X12, FHIR, PDFs, and unstructured notes Claims, EHR, HIE, pharmacy, and ancillary sources Full patient-level provenance and deduplication This enables a single longitudinal record per member, ready for quality analysis. Standardize and enrich with Terminology services & NLP Use CareEvolution’s built-in services to: Map legacy codes (ICD, CPT, NDC) to national standards (SNOMED CT®, LOINC®, RxNorm) Apply NLP/AI to extract structured data from scanned documents, PDFs, or free text Fill in missing data that current HEDIS/Stars engines overlook This improves data completeness and conformance for both traditional and digital quality engines. Convert to FHIR & prepare for dQMs Even if you’re not executing dQMs yet, CareEvolution can: Convert enriched data into FHIR R4 using US Core and CARIN profiles Validate data against NCQA’s Digital Content Services (DCS) specs Help you test digital measure outputs in parallel to existing Stars workflows This sets you up for a seamless migration to dQMs—on your timeline. Deliver insights to providers in real time Use FHIR APIs, CDS Hooks, or native integrations to: Push care gap alerts into provider workflows Send updated patient data back for reconciliation Enable bi-directional feedback between the plan and provider systems This enables more timely, point-of-care interventions that lift your current Stars scores. Previous Slide Swipe to see more Next Slide Real-world benefits for IT teams Fix dirty data now: Improve the quality and completeness of the data feeding your existing CMS Stars engine. Prepare for dQMs without replacing your infrastructure: CareEvolution works alongside what you already have. Power real-time interventions: Support your quality team’s member outreach and provider alignment efforts. Own your migration timeline: Test and deploy dQMs in parallel while continuing to meet regulatory and performance requirements. Final thought: Quality is a data problem first You don’t need to rip and replace. You need to clean and connect. CareEvolution gives IT teams the tools to modernize data pipelines, enrich clinical content, and enable the transition to dQMs—while boosting performance in the programs you’re accountable for right now. The best time to fix your data was last year. The second-best time is before the next measurement period. Want help designing your dual-path strategy for CMS Stars and dQMs? Let’s build it together. Contact us
