Case Study: HEDIS achieves higher rates and ECDS readiness with SS&C Technologies' API-driven solution

How one client prepared for NCQA digital measure expansion

HEDIS — represented in this case by a regional health plan operating across Commercial, Marketplace and Medicare with seven NCQA submissions — faced an unsustainable, manual effort to gather clinical data from 20 disparate sources as NCQA moved HEDIS measures to electronic clinical data systems (ECDS). The plan struggled with manual CCD file loads, nonstandard file layouts, identity resolution failures, outdated care gap rosters and extensive primary source verification (PSV), and engaged SS&C Technologies to provide an API-driven workflow and data quality services to address these gaps.

SS&C Technologies implemented an API-driven workflow to retrieve daily HL7/FHIR data from the plan’s FHIR server, created CCD batching for DAV-certified providers, and deployed automated cleansing and data-quality processes that earned auditor approval as standard supplemental sources. The solution automated retrieval and loading, removed much of the PSV burden, and drove measurable gains — rate improvements on 33 measures in six months, specific measure impacts such as Childhood Immunization (64–78%), A1C control (23–39%), Kidney Health (27–36%), Immunization for Adolescents (16–33%), Prenatal/Postpartum (11–35%) and Controlling High Blood Pressure (8–11%) — while improving Medicare HMO Star performance and positioning the plan for the COL-E shift to ECDS.