Case Study
Hedis Analytics Platform
The Situation
For a regional payer, accurate HEDIS scoring had become near impossible. Claims, clinical, and pharmacy data lived in separate systems with no reliable mechanism to bring them together. Reporting was delayed. Scores were wrong. And the downstream consequences were direct — Medicare Advantage reimbursement, Star Ratings, and value-based contract performance were all taking hits.
The problem wasn’t effort. The plan had teams working on HEDIS. The problem was that those teams were working without complete, current data — and year-end sprints couldn’t fix what was broken at the data layer.
Built a cloud-native HEDIS computation engine with a configurable, annually-updatable measure framework — so the platform stays current as specifications change without requiring a rebuild each cycle.
Connected claims, clinical, and pharmacy data into a unified record powering accurate, real-time HEDIS score calculation — replacing fragmented extracts with a single source of truth.
Deployed dashboards surfacing high-risk members, open care gaps, and measure performance — with provider collaboration tools that let care teams act on the data directly, not just report on it.
Talk to an Onyx expert about automating quality measurement across your full membership — continuously, not seasonally.
