In Part 1, I discussed how Hixny’s NCQA Data Aggregator Validation (DAV) program has grown since we first pursued the status in 2020. We’ve added new payers, increasing the volume of validated data by more than 75% since last year alone, and new categories of data, becoming NCQA’s first health-related social needs (HRSN) validated data stream.
And while growth in numbers on the input side is impressive, it means nothing if it doesn’t translate into quantifiable value.
How DAV Transforms Value-Based Contracting
In value-based care, success hinges on reliable, standardized measurement of quality. Health plans use HEDIS-aligned measures to support NCQA accreditation, Star Ratings, and internal performance management; while providers in accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and other value-based models are assessed against corresponding quality benchmarks derived from clinical and administrative data. Performance on these measures directly influences shared savings, incentive payments, and long-term contract viability.
By achieving and maintaining NCQA DAV, Hixny has created a standardized, pre-validated data infrastructure that health plans and value-based care providers can rely on simultaneously.
Accuracy Gains for CDPHP
When Capital District Physicians’ Health Plan (CDPHP) used Hixny’s validated data for their 2023 HEDIS reporting, they expected to gain efficiency but were shocked by the accuracy improvements.
- 7% more short-term follow-ups for newly initiated care from a baseline of 40%
- 4% more flu vaccines than were previously known from pharmacy claims alone
- 12% more patients with controlled high blood pressure—rising to 14% among patients who also had diabetes
Cancer screenings showed even more dramatic improvements:
- Breast cancer screening rose 19%
- Colon cancer screening rose 12%
- Cervical cancer screening rose 3%.
Perhaps most importantly, the data identified hundreds of exclusions—682 for colon cancer screening alone—ensuring patients weren’t inappropriately contacted about screenings they didn’t need. More accurately, excluding patients is about respecting patients, understanding individual context and humanizing how quality is measured by honoring patient history and delivering outreach that reflects empathy, context and respect.
Efficiency Gains for CDPHP
Over nearly 10 years, CDPHP had been looking at more than 30 supplemental data sources for HEDIS reporting, taking on provider installations one at a time. Finding time for physician offices to focus on something other than providing clinical care is difficult, and it’s not always easy to help them understand the data being requested.
Now that they’re engaged with Hixny, CDPHP no longer needs to work with each provider individually to set up a process for data review—they get the data through Hixny with a fraction of the effort.
For providers in value-based care contracts, the benefits are equally compelling. When health plan partners can pull validated quality data directly from Hixny, physicians are no longer subject to repeated chart review requests.
Why It Matters
These types of improvements aren’t just statistically significant, they equate to dollars—maintaining or gaining a star can be worth millions of dollars annually for a regional health plan. Even incremental gains in individual HEDIS measures can be decisive when plans are just above or below Star Rating cut points. In some cases, accurate, complete, validated data can be the difference between maintaining, gaining, or losing a Star.
For health plans operating in competitive markets, higher Star Ratings can also translate into meaningful market advantage. Plans with stronger quality scores are more visible during open enrollment and can credibly differentiate themselves to employers, members, and regulators as higher-quality options.
But the financial impact is only the most a visible example of a deeper impact. What stands out most when reflecting on this journey is that the story isn’t just about efficiency or even accuracy—it’s about fundamentally changing what’s visible in our healthcare system, and that visibility creates value that often goes unrecognized.
In value-based care, success ultimately depends on what the system can see. When data accurately reflects reality, quality measurement becomes not just fairer, but more human—rewarding care that actually happened, respecting patient context, and aligning incentives with outcomes that matter.
That’s exactly what the SHIN-NY infrastructure Hixny is part of delivers every day. It produces measurable outcomes that too often go unrecognized yet are absolutely critical to the success of value-based care in our region.
Because the SHIN-NY has enabled Hixny’s work for the past 25 years:
- Providers receive appropriate credit for the high-quality care they deliver.
- Health plans can more accurately identify and close genuine gaps in care.
- Patients benefit from a healthcare system that truly sees and measures the care they receive.
This is what a quarter century of collaboration looks like—and it’s exactly the kind of infrastructure our community needs to thrive in the future of healthcare.
