Improving HEDIS Performance Through Benchmarking
May 6, 2025 · Becky Kolinski
When you set out to improve performance for a HEDIS® measure, the first question you might ask is: Compared to what? That’s where benchmarking comes in. Benchmarking is an essential element of quality improvement because it provides concrete targets for evaluating performance.
Benchmarking can help organizations:
- Identify areas for improvement.
- Highlight areas where they perform better than their competitors.
- Create transparent performance goals for value-based care contracts.
- Align with regulatory requirements from CMS or state Medicaid programs.
- Demonstrate their value as a contracting partner.
“The shift toward value-based care highlights the need for transparent, industry-accepted benchmarking data,” says NCQA’s Madison Yaniz, Assistant Director, Measure and Data Operations. “NCQA’s HEDIS measures are the industry standard for quality measurement for health plans, care delivery systems and clinicians.”
Setting Benchmarks for Your Organization
There are many different ways to use benchmarks; for example:
- Internal vs. external. Internal benchmarking is comparing an organization’s performance to itself (e.g., a health plan comparing its HEDIS Breast Cancer Screening rates from MY 2022 to MY 2023). In external benchmarking, the organization compares its performance to that of other organizations.
- State, regional, national. Health care delivery varies at state and local levels, based on demographics, access to care, practice patterns and policy decisions. Having access to state and regional benchmarks can account for these variations when analyzing HEDIS performance.
- Average or percentile. An average rate may be a good baseline, but organizations may need to delve deeper into percentiles—25th, 50th, 75th, 90th—to better understand variation in performance across HEDIS measures.
Organizations’ needs and priorities change over time, so access to a variety of benchmarks can be useful.
Better Benchmarking with Quality Compass
NCQA’s Quality Compass® provides access to health plan performance and HEDIS and CAHPS® benchmarks to identify areas for improvement. It includes national, state and regional benchmarks, along with plan-level results for competitor analysis.
Key features of Quality Compass:
- Newly redesigned, user-friendly platform.
- Access for up to 30 users per license.
- Custom reporting tool with the ability to export reports to Excel.
- Data stratification based on age and gender.
- Trended reporting package with up to 3 years of data.
“The Quality Compass tool is the go-to resource for health care organizations seeking to improve their HEDIS performance,” says Yaniz. “In 2024, Quality Compass contained results for almost 1,300 health plan submissions across all product lines, accounting for more than 182 million covered lives. Quality Compass provides a comprehensive view of health care quality that payers, providers and states can use to improve their clinical performance.”
NCQA announced a pre-sale for Quality Compass 2025 (MY 2024). Release dates vary by product line: Commercial on July 31, Medicaid on August 29, Medicare on October 31 and Exchange on November 21.
Case Study: Premise Health
Premise Health is the largest direct health care provider in the U.S., partnering with employers, unions and health plans. It provides advanced primary care in 800 clinics, and employs more than 5,000 clinicians in 46 states and Guam. Premise Health wanted to align its quality improvement efforts with industry standards to demonstrate clinical excellence and prove its value as a contracting partner.
Premise Health used Quality Compass benchmarking data to assess its performance and identify areas for improvement. By building quality metrics into its operational processes and clearly communicating goals across the organization, Premise Health helped its team members identify and close gaps in care to improve patient outcomes. As a result, Premise Health surpassed the HEDIS MY 2023 95th percentile for key HEDIS measures like cervical cancer screening, breast cancer screening and colorectal cancer screening.*
“To improve HEDIS performance, you need to understand where you’re starting from and where you want to go,” says Jonathan Leizman, MD, Premise Health’s Chief Medical Officer. “Quality Compass provided benchmarking data to help us set clear priorities and deliver better care for our members.”
Learn More
- Visit our website to learn how you can use Quality Compass to improve HEDIS performance.
- Download the Premise Health case study.
- Register for our webinar, Mastering Quality Compass.
