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hybrid measure

hybrd_meas_ind
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A boolean indicator identifying a HEDIS measure that requires both administrative claims data and medical record review to calculate, combining the efficiency of claims-based measure calculation with the clinical specificity of chart review to capture clinical events not documented in structured administrative data. Hybrid measures allow health plans to supplement administrative data with medical record evidence for a random sample of eligible members, improving measure rates by capturing clinical services documented in medical records but not reflected in claims. Hybrid measure calculation involves random sampling of eligible members from the administrative denominator, medical record retrieval and abstraction by certified coders, and rate recalculation using both administrative and medical record evidence.

Healthcare data teams coordinate hybrid measure projects by identifying the administrative sample, managing medical record requests and abstractions, validating abstracted data quality, and integrating medical record findings with administrative data to produce final hybrid measure rates submitted to NCQA.

Standard Abbreviation

hybrd_meas_ind

Category

quality

Production DDL — FACT_QUALITY_MEASURE

FACT_QUALITY_MEASURE.sql
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
    qlty_key        INTEGER        NOT NULL  -- surrogate key,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    plan_key        INTEGER        NOT NULL  -- FK to DIM_PLAN,
    meas_yr         SMALLINT                 -- measurement year,
    hedis_meas_cd   VARCHAR(20)              -- HEDIS measure code,
    denom_ind       CHAR(1)                  -- denominator eligible,
    numer_ind       CHAR(1)                  -- numerator met,
    excl_ind        CHAR(1)                  -- exclusion indicator,
    gap_open_ind    CHAR(1)                  -- care gap open,
    star_rtg_nbr    DECIMAL(3,1)             -- star rating,
    qlty_scr        DECIMAL(5,2)             -- quality score,
    perf_thrsh_pct  DECIMAL(5,2)             -- performance threshold,
    raf_scr         DECIMAL(10,3)            -- risk adjustment factor,
    outreach_cnt    SMALLINT                 -- outreach attempts,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →

Why This Term Matters

Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.

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