Healthcare Operations & Regulatory Transformation
Clinical Quality (HEDIS/CAHPS) Dashboard Transformation
Transformed complex HEDIS and CAHPS regulatory score reporting into a transparent, provider-friendly analytics experience. The initiative standardized metric definitions, introduced explainable scoring logic, and redesigned dashboard UX to restore trust, reduce support burden, and ensure audit-ready regulatory compliance.
Year :
2025
Industry :
Healthcare / Clinical Quality Analytics
Client :
Health Plan & Provider Network
Project Duration :
Multi-phase rollout
Problem :
Healthcare providers were presented with raw HEDIS and CAHPS scores without context, explanation, or consistent calculation logic. Different product teams interpreted regulatory specifications differently, resulting in conflicting results, provider confusion, and an increase in support tickets. Leadership lacked a single source of truth for metric definitions, which undermined confidence in the analytics platform and put contract renewals at risk.
Solution :
I led a comprehensive dashboard and analytics transformation that translated CMS regulatory specifications into standardized, auditable metric logic. The solution introduced a centralized Metric Dictionary, consistent calculation methodologies, and interactive tooltips with plain-language explanations. The UX was redesigned to display percentile positioning, benchmarking, and actionable improvement pathways, making regulatory performance more understandable for non-technical provider audiences while maintaining full compliance and audit readiness.
Challenge :
Validating complex HEDIS calculations manually was time-consuming and prone to errors, especially with dozens of measures that involved exclusions, denominators, and cut points. To address this, I partnered with Data Science to create a “Golden Dataset” containing pre-calculated correct outcomes. This enabled instant validation, eliminated calculation disputes, and became the organizational standard for all future metric implementations.
Summary :
The transformation delivered significant business impact: 35% reduction in support tickets, 90% provider satisfaction, and 100% standardized metric adoption across products. Provider trust was restored through explainable analytics, regulatory disputes were eliminated, and the Metric Dictionary became a durable knowledge asset, preventing future regression. The platform now supports transparent, scalable, and regulator-ready clinical quality reporting.
More Projects
Healthcare Operations & Regulatory Transformation
Clinical Quality (HEDIS/CAHPS) Dashboard Transformation
Transformed complex HEDIS and CAHPS regulatory score reporting into a transparent, provider-friendly analytics experience. The initiative standardized metric definitions, introduced explainable scoring logic, and redesigned dashboard UX to restore trust, reduce support burden, and ensure audit-ready regulatory compliance.
Year :
2025
Industry :
Healthcare / Clinical Quality Analytics
Client :
Health Plan & Provider Network
Project Duration :
Multi-phase rollout
Problem :
Healthcare providers were presented with raw HEDIS and CAHPS scores without context, explanation, or consistent calculation logic. Different product teams interpreted regulatory specifications differently, resulting in conflicting results, provider confusion, and an increase in support tickets. Leadership lacked a single source of truth for metric definitions, which undermined confidence in the analytics platform and put contract renewals at risk.
Solution :
I led a comprehensive dashboard and analytics transformation that translated CMS regulatory specifications into standardized, auditable metric logic. The solution introduced a centralized Metric Dictionary, consistent calculation methodologies, and interactive tooltips with plain-language explanations. The UX was redesigned to display percentile positioning, benchmarking, and actionable improvement pathways, making regulatory performance more understandable for non-technical provider audiences while maintaining full compliance and audit readiness.
Challenge :
Validating complex HEDIS calculations manually was time-consuming and prone to errors, especially with dozens of measures that involved exclusions, denominators, and cut points. To address this, I partnered with Data Science to create a “Golden Dataset” containing pre-calculated correct outcomes. This enabled instant validation, eliminated calculation disputes, and became the organizational standard for all future metric implementations.
Summary :
The transformation delivered significant business impact: 35% reduction in support tickets, 90% provider satisfaction, and 100% standardized metric adoption across products. Provider trust was restored through explainable analytics, regulatory disputes were eliminated, and the Metric Dictionary became a durable knowledge asset, preventing future regression. The platform now supports transparent, scalable, and regulator-ready clinical quality reporting.
More Projects
Healthcare Operations & Regulatory Transformation
Clinical Quality (HEDIS/CAHPS) Dashboard Transformation
Transformed complex HEDIS and CAHPS regulatory score reporting into a transparent, provider-friendly analytics experience. The initiative standardized metric definitions, introduced explainable scoring logic, and redesigned dashboard UX to restore trust, reduce support burden, and ensure audit-ready regulatory compliance.
Year :
2025
Industry :
Healthcare / Clinical Quality Analytics
Client :
Health Plan & Provider Network
Project Duration :
Multi-phase rollout
Problem :
Healthcare providers were presented with raw HEDIS and CAHPS scores without context, explanation, or consistent calculation logic. Different product teams interpreted regulatory specifications differently, resulting in conflicting results, provider confusion, and an increase in support tickets. Leadership lacked a single source of truth for metric definitions, which undermined confidence in the analytics platform and put contract renewals at risk.
Solution :
I led a comprehensive dashboard and analytics transformation that translated CMS regulatory specifications into standardized, auditable metric logic. The solution introduced a centralized Metric Dictionary, consistent calculation methodologies, and interactive tooltips with plain-language explanations. The UX was redesigned to display percentile positioning, benchmarking, and actionable improvement pathways, making regulatory performance more understandable for non-technical provider audiences while maintaining full compliance and audit readiness.
Challenge :
Validating complex HEDIS calculations manually was time-consuming and prone to errors, especially with dozens of measures that involved exclusions, denominators, and cut points. To address this, I partnered with Data Science to create a “Golden Dataset” containing pre-calculated correct outcomes. This enabled instant validation, eliminated calculation disputes, and became the organizational standard for all future metric implementations.
Summary :
The transformation delivered significant business impact: 35% reduction in support tickets, 90% provider satisfaction, and 100% standardized metric adoption across products. Provider trust was restored through explainable analytics, regulatory disputes were eliminated, and the Metric Dictionary became a durable knowledge asset, preventing future regression. The platform now supports transparent, scalable, and regulator-ready clinical quality reporting.