Hybrid season is over: Why year-round quality measurement is the new reality

Each year, quality teams find themselves in a familiar predicament. The measurement year is nearly over by the time gap lists are thoroughly reviewed, resulting in a last-minute rush. Provider offices are swamped with chart requests, and nurses and abstraction vendors work tirelessly to retrieve and review records, all scrambling to gather sufficient evidence and close gaps before submission deadlines.

This retrospective abstraction was essential to a hybrid reporting model that relied on sample-based reviews. It bridged gaps left by inconsistent clinical documentation, the limitations of administrative claims data, and the fact that much of the evidence needed for HEDIS reporting was locked away in unstructured records. This "hybrid season" became the industry's default method for reconciling incomplete data after the fact.

However, the conditions that once supported this model are beginning to change, creating an opportunity for health plans to redesign their approach.

The rules of quality measurement are changing

The National Committee for Quality Assurance has announced plans to phase out hybrid reporting by Measurement Year 2029 as part of a broader transition toward digital quality measures (dQM) and Electronic Clinical Data Systems (ECDS) reporting.

This shift fundamentally changes how quality performance is measured, moving from sample-based chart review to full-population analysis. In parallel, the industry has already begun retiring select hybrid measures, including colorectal and breast cancer screening, signaling a broader move away from retrospective abstraction as a primary mechanism for quality reporting.

Operationally, this means plans can no longer assume they will “catch up during HEDIS season.” Instead, they must maintain continuous, year-round visibility into member quality performance. This shift affects nearly every major health plan in the country. HEDIS remains one of the most widely adopted quality measurement frameworks in healthcare, used by more than 90% of U.S. health plans and covering more than 235 million people.

Why the old model breaks at population scale

Manual abstraction was designed for sample-based review, retrospective validation, and seasonal catch-up workflows. It was not built for full-population measurement, year-round intervention, or continuous quality monitoring. As health plans move toward population-level measurement, the economic model begins to break down. Every chart request requires administrative coordination, every manual review consumes clinical labor, and every vendor invoice scales directly with volume.

This creates a fundamental tension for quality organizations: if your quality strategy depends on paying vendors per chart reviewed, your costs will increase as volume increases. Under digital quality measurement, that volume will only increase. The challenge is not simply that current workflows are inefficient. It is that they were designed for a fundamentally different reporting environment.

Some plans are already preparing for what comes next

In response to these changes, some health plans are transitioning to year-round medical record reviews. Rather than relying solely on retrospective abstraction during a condensed reporting season, these organizations are reconsidering how and when they access clinical evidence throughout the measurement year.

This trend highlights a broader industry realization: the future of quality measurement depends on continuous visibility into member care, rather than just retrospective, year-end reconciliations. Health plans that adapt to this model earliest will likely gain the greatest operational advantage, as reporting requirements continue to evolve.

The winners will stop thinking in “seasons”

The most successful quality organizations will move from retrospective reporting to proactive performance management.

That means:

• Continuously ingesting clinical data
• Identifying care gap evidence earlier
• Finding exclusions sooner
• Acting before the measurement year ends

In this model, quality transforms from a seasonal report card into a daily operational focus. This distinction is critical, as the financial stakes of quality performance are substantial. For Medicare Advantage plans, even minor shifts in Star Ratings can lead to significant revenue impacts.

As measurement evolves towards a continuous model, the organizations best positioned for success will be those that can swiftly identify, operationalize, and scale clinical evidence across broad patient populations.

A different approach to quality operations

As HEDIS transitions to year-round, full-population measurement, health plans face a critical challenge: scaling operational models without a proportional increase in manual effort. Much of the clinical evidence needed to close care gaps already exists within clinical records, medical documentation, and other data sources. The challenge is that this information remains difficult to access, interpret, and operationalize consistently at scale.

At Cohere Health, we believe this shift requires a fundamental rethink of quality operations–how workflows are structured, how clinical evidence is surfaced, and how organizations prepare for continuous measurement environments. While the market is evolving quickly, many operating models have yet to adapt.

The transition to year-round, population-level quality measurement is already underway. To learn more about how health plans are adapting, explore Cohere Capture.