NCQA opened Wednesday at The 16th Annual HEDIS® & Quality Improvement Summit in Baltimore with a keynote fireside chat titled "HEDIS® at the Halfway Point of the Digital Transition." Rebecca Jacobson, CEO and President of Astrata, moderated a conversation with two NCQA leaders, Wendy Talbot, Vice President of Measure and Data Operations, and Tricia Elliott, Vice President of Quality Implementation. The session covered where NCQA's phased transition stands. NCQA moved into Phase 2 of the transition this year, after launching Phase 1 with its digital introduction and early adopter program, and the speakers stressed organizations will move through the phases on different timelines depending on their own data environments.
How NCQA decides what stays in HEDIS®
The speakers described three key lenses NCQA considers when assessing measures. The first, relevance and importance, asks whether the concept still matters, with attention to patient-centered outcomes, current clinical evidence and whether the benefit outweighs any potential for harm. The second, useful signal, asks whether a measure has a large enough denominator, separates top performers from bottom performers, holds up across data sources and shows meaningful change over time. The third, feasibility and burden, asks whether the value of a measure justifies the cost of collecting the data, including readiness for digital reporting.
Ten HEDIS® measures retire in MY 2027
Four themes drove the MY 2027 retirements: reducing reporting burden from descriptive or checkbox-style measures, focusing the portfolio on signals supporting improvement and plan differentiation, removing measures highly correlated with others NCQA already collects, and stepping back from measures with digitalization challenges or declining reportability. The measures approved for retirement are:
- Diagnosed Mental Health Disorders (DMH)
- Diagnosed Substance Use Disorders (DSU)
- Documented Assessment After Mammogram (DBM-E)
- Language Description of Membership (LDM)
- Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
- Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
- Oral Evaluation, Dental Services (OED)
- Topical Fluoride for Children (TFC)
- Use of Opioids at High Dosage (HDO)
- Risk of Continued Opioid Use (COU)
All 10 come out of the March 2027 Technical Update, and NCQA plans to share the retirements through its usual communication channels.
The hybrid timeline holds, with MY 2028 still under review
NCQA's goal remains removing the hybrid specification and reporting method from HEDIS® by MY 2029, a timeline RISE covered in detail in September. For Medicare Advantage plans, the measures to watch are Controlling High Blood Pressure (CBP) and Blood Pressure Control for Patients With Diabetes (BPD), both moving to ECDS only in MY 2028, Glycemic Status Assessment (GSD), which adds ECDS in MY 2027 and moves to ECDS only in MY 2029, and Transitions of Care (TRC) and Care for Older Adults (COA), which add ECDS in MY 2028 and go ECDS only in MY 2029. NCQA noted the MY 2028 steps remain under evaluation based on industry feedback.
MY 2026 changes worth a second look
Four new measures track acute hospitalizations following outpatient colonoscopy, general surgery, orthopedic surgery and urologic surgery. The statin measures for cardiovascular disease and diabetes (SPC-E and SPD-E) are now ECDS only and dropped the I-SNP and long-term institutional denominator exclusion, a change with direct relevance for plans serving institutional members. NCQA also refreshed the Volume 2 specification template with FHIR-aligned headers, "Initial Population" in place of "Eligible Population" and "persons" in place of "members," and the speakers emphasized the refresh leaves measure intent, calculations and performance results unchanged.
From the keynote to the policy conversation
In the subsequent policy session, former CMS official Mark Newsom offered his perspective that NCQA has strong standing with policymakers and that the core HEDIS portfolio may be less exposed to some of the legal challenges affecting other Star Ratings measures following the Clover ruling. Taken together, the two sessions gave attendees the measure-level detail and the policy context for the 2027 through 2029 ratings years in one morning.
Quality data, Stars program changes and the math behind cut points anchor The RISE Star Ratings Master Class, December 14-16 at the Fairmont Scottsdale Princess in Scottsdale, Arizona, including the Quality Data Deep Dive and Cutpoint Hackathon workshops.
HEDIS® is a registered trademark of the National Committee of Quality Assurance (NCQA) and any reference thereto by RISE Health does not imply any endorsement by NCQA of RISE Health and its offerings.