CMS audits every Medicare Advantage contract annually, and quality measures now carry growing proportional weight in Star Ratings as CMS narrows the measure set under the CY2027 final rule. For a large MA plan, a single Star drop is not a reporting problem. It is hundreds of millions of dollars in lost quality bonus payments and enrollment. The margin for error is shrinking as fewer measures contribute to overall ratings.
Payer executives evaluating HEDIS improvement software need to distinguish clearly between vendors that generate reports and platforms that close gaps. This analysis evaluates six AI-driven HEDIS and Stars rating improvement platforms against criteria that reflect how quality management actually works inside a health plan operating at scale.
What to look for in a HEDIS platform in 2026
Not every platform calling itself AI-driven operates at the same level. Five criteria consistently separate high-performing HEDIS platforms from reporting tools.
AI-assisted abstraction determines whether the platform accelerates chart review using AI or relies on manual human abstraction. Plans running high-volume retrospective programs cannot afford seasonal staffing surges to cover what technology should handle year-round.
Year-round gap closure separates platforms built for continuous quality improvement from those designed for the annual HEDIS sprint. Plans that operate year-round programs consistently outperform those that rely on Q4 chart chases.
Gap closure channels indicate whether the platform activates interventions across provider offices, member outreach, community pharmacies, and at-home visits simultaneously, or routes gaps through a single channel, leaving members unreached when one approach fails.
FHIR-native architecture and dQM readiness matter because NCQA is transitioning all HEDIS measures to digital quality measures by 2030. Platforms that are not FHIR-native today will require significant architectural work before that deadline arrives.
A unified data model covering risk adjustment and quality determines whether a plan pays for the same chart twice. Plans running separate vendors for risk and quality retrieve duplicate charts, maintain two reconciliation processes, and carry two audit trails for the same member population.
How six platforms compare
Innovaccer Galaxy
Galaxy is built on a unified data model that covers risk adjustment, quality and Stars, and utilization management within a single connected architecture. A single chart retrieval workflow serves both HCC capture and HEDIS gap closure simultaneously, eliminating the duplicate retrieval that inflates costs for plans running separate vendors.
Galaxy's Multipoint Gap Closure coordinates outreach across provider offices, point-of-care alerts, community pharmacies, member engagement, and at-home visits in one continuous workflow throughout the measurement year. The platform is FHIR-native, NCQA-certified, HEDIS-compliant, and built for the 2030 dQM transition without requiring a platform migration.
Galaxy is Best in KLAS 2026 for Data Analytics Platform for Payers, scoring 90.5 against a category average of 87.2.
Seen enough? Request a Galaxy demo to see how it works for your plan.
Inovalon
Inovalon's Converged Quality solution is a widely deployed HEDIS and quality measurement platform with strong predictive analytics for gap identification and retrospective chart review. The volume of MA lives on the platform creates a comparative benchmark dataset that smaller vendors cannot replicate. Converged Quality operates primarily as a measurement and analytics layer. Plans that need gap closure execution alongside measurement typically integrate Inovalon with additional operational workflows. The data lake is an add-on purchase rather than a native component of the core platform.
Cotiviti
Cotiviti's Quality Intelligence solution has strong measure calculation accuracy. The platform operates as a measurement and reporting layer. Risk adjustment is handled separately, and plans using Cotiviti for measurement typically need a separate vendor for outreach and intervention workflows. Cotiviti's own client research indicates that most health plan clients have not yet begun integrating FHIR data for quality reporting, reflecting the gap between current architecture and where the 2030 dQM mandate will require it to be.
Reveleer
Reveleer's Quality Improvement solution focuses on AI-assisted chart retrieval and abstraction for HEDIS measures. The platform's Evidence Validation Engine supports more than 40 quality measures and is designed to accelerate abstraction efficiency and improve retrieval yield for both seasonal and year-round quality programs. Reveleer does not operate as a persistent unified data platform. Plans typically maintain a separate analytics layer for Stars performance management and gap closure orchestration alongside Reveleer.
ZeOmega
ZeOmega's Jiva Care Quality Navigator centralizes HEDIS and CMS Stars quality program data with an embedded omnichannel workflow for care gap closure. The platform covers gap identification, provider performance tracking, and member engagement through outreach via portal, SMS, email, phone, and mail. Risk adjustment is included through a dedicated navigator within the Jiva platform. FHIR alignment is in progress, with ZeOmega advising clients on FHIR and CQL standardization as part of the dQM transition.
Arcadia
Arcadia operates as a data analytics and aggregation platform, normalizing clinical, claims, and social determinant data from a wide range of EHRs, claims feeds, and HIEs. The platform surfaces quality measure dashboards and care gap identification across complex, fragmented provider networks. Arcadia does not execute gap closure interventions. Chart retrieval, member outreach, and abstraction are not capabilities confirmed within the platform.
How to evaluate HEDIS improvement software for your plan
Three questions narrow the field for most health plan buying decisions.
First: Does the platform execute gap closure, or does it produce reports that require your team to close gaps? A platform that identifies gaps but does not close them shifts the operational burden back to the health plan.
Second: Does the same platform handle risk adjustment and quality, or do you pay separately for each? Quantify the cost of duplicate chart retrieval, duplicate reconciliation, and duplicate audit trail maintenance before signing a renewal.
Third: Is the platform FHIR-native today, or will it require a migration before the 2030 dQM deadline? Retrofitting a non-FHIR architecture competes for the same internal resources needed for Stars performance improvement.
Still running separate vendors for risk, quality, and UM? See what one connected solution looks like at innovaccer.com
Frequently asked questions
What is HEDIS improvement software?
HEDIS improvement software automates the identification, tracking, and closure of quality measure gaps for health plans reporting to NCQA. Advanced platforms go beyond measurement to orchestrate multi-channel outreach, chart retrieval, and real-time gap prioritization. The distinction between measurement and improvement is whether the platform closes gaps or only counts them.
What makes a HEDIS platform FHIR-native?
A FHIR-native platform is built on HL7 FHIR data standards from its foundation rather than retrofitting FHIR APIs onto a legacy data model. NCQA's 2030 dQM transition requires FHIR and CQL-formatted quality measures. Platforms that are FHIR-native today will not require an architectural migration. Platforms that are FHIR-compatible may still store and process data in proprietary formats, creating translation layers that introduce latency and error when digital reporting becomes mandatory.
Why does a unified data model matter for HEDIS performance?
Plans running separate vendors for risk adjustment and quality retrieve the same member charts twice, maintain two separate reconciliation processes, and carry two audit trails for the same population. A unified data model eliminates this duplication. One chart retrieval serves both HCC capture and HEDIS gap closure simultaneously, reducing cost, reconciliation burden, and audit risk.
What should health plans prioritize when evaluating HEDIS platforms in 2026?
Three questions cut through most vendor evaluations. Does the platform execute gap closure or produce reports? Does it handle risk and quality on one data model? Is it FHIR-native today? The answers eliminate most of the vendor landscape for plans that need a consolidated, execution-oriented solution built for the regulatory environment that has already arrived.
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This analysis reflects publicly available information as of June 2026, including vendor websites, press releases, and publicly announced product documentation. Vendor capabilities described are based on publicly available sources and do not represent independent audits. Health plans should conduct their own due diligence when evaluating technology vendors. This content was produced by Innovaccer. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). FHIR is a registered trademark of Health Level Seven International.