Post CMS STARS April 30, 2025 From reporting to results: How health plans can operationalize Digital Quality Measures (dQMs) to improve CMS STARS performance Health plans know the stakes: CMS STARS ratings directly impact reimbursement, bonus payments, and member retention. But traditional approaches to quality measurement are reactive—focused on retrospective reporting, manual chart abstraction, and provider outreach that comes too late. Digital Quality Measures (dQMs), powered by FHIR® and integrated into the right data platform, enable health plans to shift from lagging indicators to proactive, real-time improvement—at scale. Why this shift matters for health plans CMS is pushing toward digital-first quality reporting. But it’s not just about compliance—it’s about building the infrastructure that allows dQMs to drive operational impact. When dQMs are embedded into workflows and fueled by complete, accurate data, they become a tool for real-time intervention, not just scorekeeping. The platform playbook for digital quality success To succeed with CMS STARS digital measures, health plans need more than just data—they need an engine. Here’s what leading plans are doing: Aggregate & normalize multi-source member data Ingest structured and unstructured data from EHRs, HIEs, claims systems, and more (HL7v2, C-CDA, FHIR, X12). Match members using privacy-preserving record linkage (PPRL) while maintaining full data provenance. Standardize & enrich for accuracy Convert proprietary and inconsistent coding to national standards like SNOMED CT®, LOINC®, and RxNorm. Use NLP and AI to extract clinically relevant facts from notes—capturing diagnoses, screenings, immunizations, and more. Convert to FHIR & ready for digital execution Structure the data into FHIR R4-compliant resources (e.g., US Core, CARIN Blue Button) to support dQM execution engines like NCQA’s Digital Content Services (DCS). Secure, compliant, and auditable infrastructure Operate within environments aligned to HITRUST, NIST SP 800-53, and other standards to protect PHI and ensure audit-ready data flows. Push dQM insights into provider workflows Drive timely action by embedding care gap alerts and risk indicators directly into provider EHR workflows via bi-directional data exchange—closing gaps faster and reducing provider friction. Previous Slide Swipe to see more Next Slide The results health plans can expect Plans implementing this platform-based approach to digital quality measures see: Faster care gap closure through real-time workflow integration Lower operational burden with less manual chart chasing Improved CMS STARS scores with better data, sooner Tighter provider collaboration by embedding insights where care happens Building the foundation for more than STARS By investing in digital quality infrastructure today, health plans are future-proofing their capabilities for value-based care, real-time analytics, interoperability, and member experience improvement. Bottom line? Digital quality measures offer more than compliance—they’re a lever for transformation. Health plans that operationalize dQMs through platform-driven integration can boost CMS STARS performance, reduce administrative drag, and make quality improvement truly actionable. Ready to transform your quality improvement initiatives and elevate your CMS Star Ratings? Learn how CareEvolution’s platform can help you move digital quality measures from calculation to meaningful action. Contact us
