Practice Transformation & Quality Improvement
Redesign care delivery to lift the measures that matter
HEDIS and Star measures drive bonuses, withholds and network standing, yet care gaps stay open when workflows never close them. We redesign care delivery and operational workflows with your team, then capture the result as structured, coded data that payers can see.
- HEDIS and Star Ratings
- Care gap closure and AWV campaigns
- MIPS and ACO quality
Who it's for
Built for the organizations that carry this work
Each line of business scores quality under a different framework, and most practices answer to several at once.
Physician practices
Solo, small and multi-provider groups, primary care and specialty, seeking stronger quality performance and operational efficiency.
Medicare Advantage networks
Star Ratings measures and the plan's provider quality or pay-for-performance program.
ACOs and Medicare fee-for-service
MSSP APP Plus or MIPS, where the same clinical measures decide shared savings and payment adjustments.
Medicaid and commercial contracts
Medicaid managed care quality programs (in New York, QARR), commercial pay-for-performance, and marketplace Quality Rating System measures.
Institutions and health systems
Hospital-affiliated practices and care management programs aligning clinical operations with value-based contracts.
What we do
What you receive
Focus areas include cancer screenings, diabetes management, blood pressure control, behavioral health follow-up, medication management and preventive care access.
- 01
HEDIS performance strategy
A payer-by-payer map of which measures each contract pays on, a measure gap analysis against benchmarks, and a priority action plan.
- 02
Care gap closure workflows
Gaps closed across preventive, chronic and behavioral health domains through EHR-integrated alerts, quarterly outreach campaigns and standing order protocols for labs and screenings.
- 03
Annual Wellness Visit campaigns
Planning and execution that raises AWV completion and supports multiple quality and chronic care measures at once.
- 04
Care team role optimization
MA pre-rooming checklists, RN care manager support for complex patients and QI coordination, so everyone works at the top of their license.
- 05
Behavioral health integration
Same-day warm handoffs and follow-up processes aligned to the FUH and FUI follow-up measures.
- 06
Population health technology
Registry management, gap alert configuration and payer supplemental data feeds, with CPT II capture checked monthly, configured so they are actually used.
How it works
How an engagement runs
- 10–30 days
Immediate
Confirm MIPS or APP measure selection and registry, pull gap reports from every pay-for-performance payor, put the annual wellness visit and CPT II workflow in place, and update templates for the October ICD-10-CM code set.
- 230–90 days
Short term
Diabetes bundle, blood pressure recheck protocol, cancer screening orders at the visit, tobacco, depression and social needs screening at every visit, and adherence outreach with pharmacies.
- 390–180 days
Medium term
PCMH recognition or renewal, behavioral health follow-up and post-discharge workflows driven by ADT alerts, and supplemental data feeds to plans.
- 4180+ days
Long term
Value-based arrangements with Medicaid plans, the MSSP participation decision, pediatric immunization and well-care, and alignment with the next Star Ratings measure sets.
Implementation timeline from our quality opportunity analysis. For most measures the last value of the year counts, so earlier work moves more of the rate.
Program facts
Codes, requirements and rules
What is changing in quality measurement
Status as of September 2026. Final, draft and proposed items are labeled.
- MIPS performance year 2026 (final): 75-point performance threshold, payment adjustment up to ±9%, and category weights of Quality 30, Cost 30, Promoting Interoperability 25 and Improvement Activities 15.
- Star Ratings (final): eleven mostly administrative measures leave between the 2028 and 2029 ratings, so the clinical measures carry more of the rating. Improving or Maintaining Physical and Mental Health weigh 3x, and Depression Screening and Follow-Up arrives for 2029.
- Draft 2027 Star Ratings: half of all cut points moved up, almost entirely on HEDIS measures, so performance that held steady can still lose ground.
- HEDIS MY2026 (final): Asthma Medication Ratio and Medical Assistance with Smoking Cessation retire; Blood Pressure Control for Patients with Diabetes, Asthma Follow-Up after Exacerbation and Tobacco Screening & Cessation are new.
- Digital HEDIS: chart-sample (hybrid) reporting retires on a schedule, with blood pressure measures moving to electronic reporting in MY2028, glycemic status, Transitions of Care and Care for Older Adults in MY2029, and fully digital HEDIS by MY2030.
- MSSP APP Plus (proposed, CY 2027 PFS proposed rule): trimmed to eight quality measures.
See the full CY 2027 Star Ratings, HEDIS & Quality FAQ for sources and status of each change.
CPT II codes that report a closed gap
CPT II codes carry the result to the payer at the time of the claim, so the gap closes without waiting for chart review.
Controlling High Blood Pressure; BP Control for Patients with Diabetes
- CPT II codes
- 3074F · 3075F · 3077F / 3078F · 3079F · 3080F
- What they report
- Most recent systolic and diastolic ranges
Glycemic Status Assessment
- CPT II codes
- 3044F · 3051F · 3052F · 3046F
- What they report
- Most recent A1c range
Eye Exam for Patients with Diabetes
- CPT II codes
- 2022F–2026F · 2033F · 3072F
- What they report
- Retinal exam or imaging result, or low risk
Breast Cancer Screening
- CPT II codes
- 3014F
- What they report
- Screening mammography results documented and reviewed
Colorectal Cancer Screening
- CPT II codes
- 3017F
- What they report
- Screening results documented and reviewed
Tobacco Screening & Cessation
- CPT II codes
- 1000F · 1036F · 4004F
- What they report
- Tobacco use assessed; non-user; cessation intervention given
Transitions of Care
- CPT II codes
- 1111F
- What they report
- Discharge medications reconciled with the current list
Care for Older Adults
- CPT II codes
- 1159F · 1160F · 1170F
- What they report
- Medication list, medication review, functional status
Payers differ in which supplemental codes they accept; confirm with each plan.
Measures we work on
Diabetes
- Glycemic Status Assessment
- Eye Exam for Patients with Diabetes
- Kidney Health Evaluation
- Blood Pressure Control for Patients with Diabetes
- Statin Use in Persons with Diabetes
Cardiovascular
- Controlling High Blood Pressure
- Statin Therapy for Patients with CVD
Preventive and screening
- Breast, Cervical and Colorectal Cancer Screening
- Adult Immunization Status
- Tobacco Screening & Cessation
- Prenatal & Postpartum Care
Behavioral health
- Depression Screening & Follow-Up
- Follow-Up After Hospitalization or ED Visit for Mental Illness
- Antidepressant Medication Management
- Initiation & Engagement of SUD Treatment
Chronic care and coordination
- Transitions of Care
- Care for Older Adults
- Medication Adherence (diabetes, RAS antagonists, statins)
- Plan All-Cause Readmissions
- Social Needs Screening & Intervention
Pediatric
- Well-Child and Well-Care Visits
- Childhood and Adolescent Immunizations
- Chlamydia Screening in Women
FAQs
Common questions
My quality scores went up last year. Why is my plan incentive at risk?
Because the bar moved more than you did. For the draft 2027 Star Ratings, half of all cut points rose, almost entirely on HEDIS measures: Kidney Health Evaluation moved 7 to 10 points, Colorectal Cancer Screening 4 to 11 points, Controlling Blood Pressure 4 to 5 points. Plan incentive contracts are written against those thresholds, so the same performance can pay less.
Which measures should my practice own in 2027?
The ones that land in your exam room: Controlling Blood Pressure, diabetes glycemic control, Kidney Health Evaluation, Eye Exam (chart review no longer counts), breast and colorectal screening, three medication adherence measures, and the new Functional Status Assessment, Polypharmacy and Opioid-Benzodiazepine measures. The administrative measures you never controlled are leaving.
NCQA is going digital. What does that mean for how my staff documents?
NCQA is retiring chart-sample (hybrid) reporting on a schedule through MY2030. In plain terms, a blood pressure written in a progress note will stop counting; only a structured, coded value transmitted electronically will.
Why report CPT II codes if the result is already in the chart?
Because the plan sees the claim, not the chart. A CPT II code on the claim, or a validated supplemental data feed, is how a result documented in your EHR reaches the payer's measure calculation.
Ready to simplify the complex?
Let’s look at your program together.
A consultation is a working conversation about your panel, payers and EHR, and whether this service fits. Please do not send patient information.
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