Consulting Services
Quality expertise that moves your Star Ratings, HEDIS rates, and compliance forward.
Our technology streamlines compliance. Our consultants bring the hands-on experience to help you act on it. Every engagement is led by professionals who have run quality, HEDIS, and Stars programs inside health plans, and we work as an extension of your team, whether you need advice, a defined project, or fully managed support.
Stars & HEDIS Improvement
We pinpoint the measures with the greatest impact on your overall rating and build practical, accountable plans to move them, across HEDIS, CAHPS, HOS, Part D, and operational measures.
- Star Ratings gap analysis, cut-point trend modeling, and "distance-to-next-star" forecasting
- Measure prioritization by weight, opportunity size, and feasibility
- Member, provider, and pharmacy interventions to close care gaps
- Supplemental data strategy and coding/documentation improvement
- Medication adherence and CAHPS/member-experience improvement programs
- Health equity readiness and stratified performance analysis
- Quality governance: committees, workplans, and accountability reporting
Healthcare Analytics & Dashboarding
We design and build the reporting your teams actually use: accurate, timely, and focused on the actions that change outcomes.
- Executive quality and Stars dashboards in Power BI and Tableau
- Prospective rate tracking and year-end projections
- Provider and practice scorecards, gap-in-care lists, and attribution reporting
- Data model design, measure logic validation, and data-quality checks
- Predictive models to target members most likely to close gaps or disenroll
- Self-service reporting and analytics enablement for your staff
Real-World Evidence
For payers, providers, and life-sciences partners, we turn real-world data into evidence that supports clinical, operational, and value decisions.
- Study design, protocols, and analysis plans for retrospective studies
- Cohort building from claims, EHR, pharmacy, lab, and registry data
- Outcomes, utilization, cost, and treatment-pattern analyses
- Program and intervention effectiveness evaluation
- Data sourcing, linkage, and fitness-for-purpose assessment
- Reports, publications, and stakeholder presentations
NCQA HEDIS Audit & Certification
We prepare health plans for a smooth NCQA HEDIS Compliance Audit™, and help software and data vendors get their HEDIS measures through NCQA Measure Certification.
- Mock audits and readiness assessments against NCQA HEDIS standards
- HEDIS Roadmap preparation and documentation review
- Supplemental data source documentation and primary source verification support
- Medical record review validation preparation and corrective action planning
- ECDS and digital measure readiness
- Measure Certification support for vendors: logic review, test-deck preparation, and issue resolution
Vendor Oversight
Your HEDIS and Stars results depend on vendors. We put structure and accountability around them, and around delegated functions subject to NCQA and CMS oversight.
- Vendor selection, RFP development, and contract/SLA design
- Oversight of certified HEDIS software, chart retrieval/abstraction, and supplemental data vendors
- Performance monitoring, scorecards, and joint operating committees
- Delegation oversight: pre-delegation assessments, annual audits, and corrective action plans
- Data transfer and file-quality validation
- Oversight documentation aligned with NCQA and CMS requirements
HEDIS Project Management & Submission
HEDIS season leaves no room for slipped deadlines. We manage the full cycle, or step in where you need extra hands, so your submission is accurate and on time.
- Integrated HEDIS project plan, milestones, and status reporting
- Data extraction, load, and reconciliation with your certified software vendor
- Hybrid medical record review: chase strategy, abstraction oversight, and over-reads
- Rate review, benchmarking, and trend analysis before data lock
- IDSS submission, attestation, and patient-level detail file preparation
- Post-season lessons learned and process improvement for next year
How We Work
Engagements are scoped to what you need: strategic advisory, a defined project, or ongoing managed support.
Assess
Review current performance, data, processes, and vendor relationships to find the biggest opportunities.
Plan
Agree on priorities, targets, owners, and a realistic timeline tied to regulatory deadlines.
Execute
Build, implement, and manage alongside your team, with the tools to keep work on track.
Measure & Sustain
Track results, report progress, and transfer knowledge so improvements last.
Consulting and Technology, Working Together
Our consultants bring decades of combined, hands-on experience in managed care quality, HEDIS, Stars, accreditation, and analytics. Where it helps, we pair advisory work with JustCQ's workflow automation, so documentation, alerts, and progress tracking run on a platform instead of spreadsheets.
Talk to a Consultant
Ready to improve your quality performance?
Tell us where you want to be by the next Star Ratings release or HEDIS submission, and we'll show you how to get there.
Schedule a Consultation