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Points of Light 2025 Case Study 14
Increasing HEDIS Rates with an NLP-Driven Prospective Review Process
Author
Boyd Stewart
Author
Aurene Wilford
All stakeholders in this case study wanted to improve the accuracy of HEDIS reporting as well as the HEDIS quality rates for key populations. Astrata worked with Capital District Physicians’ Health Plan (CDPHP) and Community Care Physicians (as well as other healthcare organizations) to build an NLP software that easily extracts needed data from clinical notes, easing the administrative and physician documentation burden. Continual alignment was maintained throughout the process, and as a result, HEDIS quality measures improved and the speed of getting HEDIS reports increased, all while maintaining high report accuracy.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved Through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Writer
Natalie Hopkins
Designer
Jess Wallace-Simpson
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2025 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.