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DIGITAL QUALITY MEASURES

Digital Quality Measures (dQM) for Health Plans

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26
Consecutive years of NCQA HEDIS® Measure Certification1
100%
Validation coverage for NCQA digital quality measures, one of three vendors2
70%
Of Medicare Advantage enrollees in 4+ Star plans run on our platform3
#1
Best in KLAS Quality Measurement & Reporting (Payer), 20264
Best in KLAS 2026 Quality Measurement & Reporting (Payer) Badge

Digital Quality Measure Readiness for Health Plans

Digital quality measures (dQMs) are quality measures written in Clinical Quality Language (CQL) and calculated from electronic data formatted to the HL7® FHIR® standard, rather than from chart review. NCQA plans to phase out the HEDIS® hybrid reporting method by measurement year (MY) 2029 and make HEDIS reporting fully digital by MY 2030.

Most vendors will ask you to cut over to a new engine and validate their work against your live program. We won’t. Inovalon’s Digital Quality Measures solution converts your existing data feeds to FHIR format and lets your team test NCQA digital measures in a sandbox while your current HEDIS submission runs unchanged. You see which measures are at risk of a rate drop and plan the cutover on your own timeline.

In 2026, NCQA validated Inovalon’s Converged Quality measure engine for digital quality measures, making Inovalon one of three vendors with 100% validation coverage. Converged Quality also earned its 26th consecutive NCQA HEDIS Measure Certification.

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Test Digital Without Impacting Your Current Rates

Run NCQA digital measures in a sandbox while your production HEDIS submission runs unchanged. Your current reporting, feeds, and submission path stay in place.

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One Contract. One Team to Call.

One solution encompassing dQM engine, ingestion of data formatted to the HL7 FHIR standard, medical record review, member outreach, and CMS Stars analytics – all delivered by one partner to reduce integration complexity and provide clear, end-to-end accountability.

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Experts Who've Sat in Your Seat

Our team includes former health plan quality leaders, HEDIS auditors, and NCQA staff, bringing firsthand experience and expertise that informs every solution we deliver.

Prepare for 2030 Without Disrupting 2026

Identify rate risks early, before they impact your CMS Star Rating, approach audits with confidence in the integrity of your data, and begin operational improvements on a timeline you control.

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Your Rates Stay Protected

The real risk in the transition isn’t the engine: it’s the rate drop that can occur when FHIR-formatted clinical data replaces chart-abstracted hybrid data. We help you see what’s coming and manage it before it impacts your submission.

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You Start This Year, Not 2029

Keep your existing Inovalon data feeds. We normalize them to align with the FHIR standard so your team can begin comparative testing now, without re-plumbing your source systems or waiting for perfect data.

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Your Audit Team Has Answers

See exactly why each member was included, excluded, or flagged, traced back to the source FHIR resource. Every auditor inquiry is met with clear, defensible answers.

HOW IT WORKS

How Inovalon Runs dQM Testing Alongside Your HEDIS Submission

Your existing HEDIS workflow keeps running exactly as it does today. Readiness happens in parallel, in a sandbox separate from your production workflow. When you're ready to cut over, you cut over on your timeline, not ours.

  • Existing data feeds converted to FHIR-formatted data, with no source-system changes
  • Sandbox test projects to run dQMs in parallel
  • NCQA-validated digital measure packages
  • Rate variance modeling before you submit
  • Expert support, not a ticket queue
  • Member-level explainability traced to source FHIR-formatted data
The Dual-Track Architecture

Production Track

Your HEDIS submission, untouched

Existing feeds, NCQA interactive data submission system (IDSS) and CMS patient-level detail (PLD) exports, live submission through 2029.

Running in Parallel

Readiness Track

Testing in a sandbox environment with FHIR-formatted data

Existing feeds converted to align with FHIR standard, NCQA-validated digital measures, voluntary comparative testing 2026 to 2029.

Your production HEDIS submission runs unchanged
A woman with blonde hair and blue eyes, wearing a blue top, smiles slightly at the camera. In the background, a bookcase filled with books and framed photographs hints at Courtney Breece’s inviting and thoughtful space.

EXPERT POINT OF VIEW

Led by People Who Helped Build the Standards

Inovalon's dQM strategy is led by quality leaders who built their careers inside NCQA, with expertise not just in implementing the standards but in writing and validating them.

“The plans that win the dQM transition won’t be the ones who picked the flashiest engine. They’ll be the ones that prepared not only for a dQM engine, but also the retirement of the hybrid methodology and were incrementally planning ahead to treat 2026–2029 as an opportunity for operating model redesign. Protecting current performance while their data, people, and processes evolve toward digital.”

Courtney Breece

VP, Product Management, Converged Quality, Inovalon
Former Assistant Director, NCQA Measure Validation

FAQ

Frequently Asked Questions About Digital Quality Measures

Digital quality measures (dQMs) are quality measures written in Clinical Quality Language (CQL) and calculated from standardized electronic data formatted to the HL7 FHIR standard. NCQA plans to make HEDIS reporting fully digital by measurement year (MY) 2030. Learn more in our Roadmap to Readiness.

NCQA plans to phase out the hybrid reporting method by MY 2029 and make HEDIS reporting fully digital by MY 2030. The hybrid method is retired one measure at a time, where some measures move to Electronic Clinical Data Systems (ECDS) reporting and others revert to administrative-only reporting. Colorectal Cancer Screening was the first to lose the hybrid method, in MY 2024.

The largest risk is a rate drop when FHIR-formatted clinical data replaces chart-abstracted hybrid data. Chart review often captures care that is missing from structured electronic records, and lower rates on HEDIS measures used in the Star Ratings program can lower a plan’s Star Rating. Inovalon’s sandbox lets your team compare digital and current rates measure by measure, so you can see which measures are at risk before they affect your submission.

Yes. Inovalon runs NCQA digital measures in a sandbox that is separate from your production workflow. Your current HEDIS submission, data feeds, and NCQA-certified measures stay in place through 2029. Existing Inovalon data feeds are converted to FHIR-formatted data, so your team can start comparative testing without changing source systems.

Yes. In 2026, NCQA validated the measure engine in Inovalon’s Converged Quality for digital quality measures, and Inovalon is one of three vendors with 100% validation coverage for NCQA’s digital quality measures. Converged Quality also holds 26 consecutive years of NCQA HEDIS Measure Certification.

One contract covers the dQM engine, ingestion of FHIR-formatted data, medical record review, member outreach, and CMS Stars analytics. Every member-level result can be traced back to the FHIR record it came from, and teams get support from former NCQA staff and HEDIS auditors. For a full checklist, download Your Digital HEDIS Transition.

TESTIMONIALS

Why Health Plans Choose Inovalon for HEDIS and dQM Readiness

Hear from health plan quality leaders on how Inovalon supports accurate HEDIS reporting and Star Ratings performance.

“

Being able to accurately and completely report our HEDIS and Stars rates on a regular basis, and figure out where our gaps in care are, to help make sure that we are providing the care to our members timely, and then capturing the data about the care accurately. That's awesome.

Terance FowlerExecutive Director of Quality, Aetna

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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

HL7, FHIR and the FHIR [FLAME DESIGN] are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

1 “Inovalon’s Converged Quality Achieves 26th Consecutive NCQA HEDIS® Certification,” Business Wire, July 23, 2026, https://www.inovalon.com/news/inovalons-converged-quality-achieves-25th-consecutive-ncqa-hedis-measure-certification/

2 “Inovalon’s Quality Measurement Solution Earns Top Ranking From Black Book Research,” Business Wire, June 23, 2026, https://www.businesswire.com/news/home/20260623718274/en/Inovalons-Quality-Measurement-Solution-Earns-Top-Ranking-From-Black-Book-Research

3 “Inovalon Powers 70% of Medicare Advantage Enrollees in 4+ Star Plans, Continuing to Outperform National Averages in 2026 CMS Star Ratings,” Inovalon, October 30, 2025, https://www.inovalon.com/news/inovalon-powers-70-of-medicare-advantage-enrollees-in-4-star-plans-continuing-to-outperform-national-averages-in-2026-cms-star-ratings/

4 Inovalon, Converged Quality achieves Best in KLAS press release, February 4, 2026, https://www.inovalon.com/news/inovalons-converged-quality-solution-achieves-best-in-klas-for-quality-measurement-and-reporting-analytics/

Resources

dQM Resources

Explore buyer’s guides, webinars, and readiness checklists to help your health plan move from hybrid HEDIS reporting to digital quality measures, whether you are shortlisting vendors or still building your plan.