Use Case: HEDIS Measures
Run your HEDIS measures directly on FHIR data. One CQL logic layer you can audit, reuse across Stars, Medicaid and commercial, and update without rebuilding it every measurement year.
What you can do with Firely
Execute HEDIS measures as computable logic
Run NCQA’s FHIR- and CQL-specified measures against your FHIR data and get a FHIR MeasureReport back. No manual re-translation of measure specs into proprietary rules.
Reuse one logic layer across
programs
The same measure logic serves HEDIS, Star Ratings, state Medicaid reporting and QRS. Implement once instead of maintaining overlapping rules in separate tools.
Calculate continuously, not once a year
Measures run against live FHIR data, so you see where you stand during the measurement period, not after it closes.
Keep results explainable
Standardised CQL artefacts and FHIR MeasureReports let you trace every result back to its data inputs, for your auditor, your regulator and your provider network.
Your measure logic lives in more places than it should
A health plan reporting HEDIS rarely reports only HEDIS. The same clinical concepts show up in Star Ratings, in state Medicaid contracts, in QRS, and in internal quality initiatives, implemented separately, in different tools, by different teams.
That duplication is expensive on its own. It becomes a risk when the specifications move. And three things are moving at once.
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The specifications have been redesigned
Six new ECDS measures. Three moved to ECDS-only reporting — administrative and hybrid methods are no longer accepted for those.
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ECDS becomes the only route
NCQA’s stated aim is ECDS-only reporting for HEDIS measures. That is a change in which data you need, not just how you calculate it.
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Fully digital
NCQA calls 2030 its north star, and CMS has set the same goal for its own programmes.
None of this is a mandate. Traditional HEDIS reporting remains fully accepted, and NCQA is explicit that the pace depends on market readiness.
Where HEDIS performance turns into revenue
HEDIS reporting is not one obligation with one consequence. Depending on your lines of business, the same measure logic feeds rating programmes, state contracts and accreditation, each with its own money attached.
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Medicare Advantage
13 of 43
Star Ratings measures are HEDIS measures — the largest single source
Star Ratings drive rebate dollars and bonus payments, and cut points move every year.
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Medicaid
Core Sets
Several Child and Adult Core Set measures are built on HEDIS specifications
They carry the ECDS reporting methodology, so state reporting moves with your HEDIS capability.
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Commercial & Exchange
Accreditation
NCQA Health Plan Accreditation and Health Plan Ratings depend on HEDIS reporting
That is what employers, brokers and marketplaces compare you on.
How most plans measure today
After the measurement period closesYou learn what your rating will be.
With measures running on live FHIR data
During the measurement periodYou learn what you can still change.
How it works
Your FHIR data stays where it is. Firely Server runs inside your environment and executes against your existing data pipelines and governance, no rip-and-replace. You run the measures; the results are yours.
And there is more FHIR data every year. CMS-0057-F puts patient, provider and prior authorization data behind FHIR APIs for Medicare Advantage, Medicaid and Exchange plans, so a growing share of your quality-relevant data is FHIR-native by default. For what is not there yet — historical data, and sources that will not speak FHIR any time soon — a translation layer, ideally a FHIR gateway, feeds the engine.
Claims · clinical · ECDS sources, in your existing pipelines
FHIR Measure + Library with CQL — no manual re-implementation
Production CQL engine
$evaluate-measure
Patient level and population level, ready for submission
Want the technical detail? Read about CQL on FHIR →
Questions we get asked
Does our engine need to be certified?
Yes — and this is the part most teams discover late. NCQA’s guidance is that if you run digital measures on any CQL engine, that implementation must be certified through NCQA.
There is a defined path: licence the digital content, pass NCQA’s test executions, then report official results. Organisations that complete it can display the NCQA-Certified Digital HEDIS® seal.
Do we still need a HEDIS Compliance Audit?
Yes. NCQA has been clear that HEDIS audits continue to be required, and will evolve to account for digital data and new use cases.
Going digital does not remove the audit — it changes what the auditor looks at. Standardised artefacts and traceable MeasureReports are designed to make that conversation easier, not to replace it.
Can we move gradually?
Yes, and NCQA built for it. Organisations can run one measurement year of parallel reporting to validate digital results before submitting them officially, while still submitting traditional HEDIS reporting by the regular deadline.
That parallel year is the natural place to start.
Does CQL hold up at scale?
Firely Server is a production FHIR server with a built-in CQL engine, deployed on-premises and in cloud, and performance at scale is where we focus.
What if we want to switch vendors later?
Your measure logic stays yours. Because it is expressed in open, standardised CQL artefacts and the outputs are FHIR MeasureReports, you can take it with you.
That is a property of the standard, not a promise from us.
We’re not a health plan. Is this relevant?
HEDIS submission to NCQA is a health plan activity. But HEDIS performance travels: payers hold provider organisations to the same measures in value-based contracts, and the technology vendors and data platforms serving plans run the same logic on their behalf.
The engine is the same in all three cases — what differs is who owns the submission.
Why Firely
- We helped build the standard this runs on. Firely’s team contributes to HL7 FHIR and its implementation guides. When NCQA publishes a measure as a FHIR Measure and Library with CQL, those are formats our people helped define, so you are not working with one vendor’s interpretation of the spec.
- The industry builds on our tooling. The Firely .NET SDK has passed 5 million downloads, across 13 years of FHIR work and more than 32,000 commits.
- We teach this work. Our course Implementing CQL based Quality Measures trains the teams doing it. Explaining it to other people’s engineers is how we know where it gets hard.
- We partner where the data lives. Firely and IMAT Solutions have a strategic alliance for digital HEDIS and quality measurement: IMAT aggregates and normalises clinical data from provider EHRs, health information exchanges and laboratories; Firely evaluates it against HEDIS specifications with FHIR and CQL. Read the announcement →
Ready to run your HEDIS measures on FHIR?
You do not need to overhaul everything at once. Most payer teams start with a focused set of measures, validate the results, then scale.
In 30 minutes we will walk through which measures you report, where your data sits today, and what a parallel reporting year would look like for your team. No commitment.