Evaluation of an End-to-End HEDIS Product Operating Model: Translating Quality Measurement into Repeatable Digital Capabilities

Abstract

HEDIS programs are frequently executed as seasonal reporting efforts driven by deadlines rather than as continuously managed digital capabilities. This operating pattern often produces late data remediation, inconsistent measure logic interpretation, heavy manual evidence works, and rework cycles that limit scalability across Medicare, Medicaid, and Commercial lines of business. This paper proposes and evaluates an end-to-end HEDIS Product Operating Model (POM) that translates quality measurement into repeatable capabilities spanning data ingestion, measure computation, evidence/provenance, governance, and operational workflows. The model defines product boundaries, decision rights, a standardized lifecycle from intake through submission readiness, and measurable service levels for feed health, measure stability, evidence completeness, and exception resolution. We present a methodology combining design-science artifact development with an operational evaluation approach (pre/post or pilot/control) using metrics such as cycle time, rework rate, chart retrieval burden, and submission readiness. The proposed operating model enables consistent execution across measures and lines of business while increasing auditability and reducing operational friction.