National Committee for Quality Assurance (NCQA) leaders Eric Musser and Rachel Harrington, Ph.D., spoke during the final day of RISE National 2026 about the organization’s key priorities this year and how they align with the Centers for Medicare & Medicaid Services (CMS) priorities and programs.
Musser, vice president for federal affairs, and Dr. Harrington, senior product strategist. emphasized that CMS and NCQA are converging on a shared agenda—one that prioritizes measurable outcomes, reduces administrative burden, and standardizes clinical data to support real time quality improvement.
Musser underscored the pressure CMS is facing from Congress to control Medicare Advantage cost growth and bring greater transparency to quality ratings. He noted that policymakers are calling for “stability and predictability for the program,” paired with strong guardrails that reflect mounting congressional scrutiny of Medicare Advantage spending.
That same expectation for stability, he pointed out, is being echoed right back to CMS from plans and vendors: “They too are hearing from their stakeholders about that same need for stability and predictability.”
This bidirectional pressure has resulted in increasing philosophical and operational alignment between CMS and NCQA
Shared priority: Streamlining measures and elevating outcomes over process
One of the strongest points of their shared mission is the shift toward leaner, outcomes‑focused measurement sets.
Musser highlighted CMS’ recent rulemaking as “a clear long‑term signal… to streamline the measure set [and] focus on outcomes, access, and experience”. CMS is cutting 12 process-heavy measures in coming years and elevating HEDIS® measures to 50 percent of Star ratings weighting, reinforcing the move away from administrative process metrics.
NCQA’s modernization work mirrors this stance, Musser said. He explained that NCQA is redesigning quality frameworks so that “measurement is faster, less burdensome, and more connected to the outcomes patients and clinicians actually experience” and to ensure that data “arrives in time to support care delivery and not after the fact.”
In short: CMS is reshaping federal regulation toward outcomes, and NCQA is restructuring its accreditation and measurement frameworks to match.
Shared priority: Reducing burden through digital, interoperable clinical data
Both CMS and NCQA are shifting toward clinical data and digital measurement to replace manual chart review and reduce administrative burden.
Harrington addressed a key challenge for plans—bundled payments that obscure underlying services in claims data. The solution aligns squarely with CMS’ vision for digital quality measures.
“The clinical data should help us disentangle this and get to that level of detail so that you can really recognize what is happening within an encounter,” she said.
Musser reinforced this direction, noting national alignment around moving “quality measures [to] flow out of clinical data” as the industry transitions beyond claims based measurement. This syncs with CMS’ own timelines for the interoperability and prior authorization final rules, digital quality measurement standards, and increased use of USCDI and FHIR-based exchange.
Shared priority: Responsible AI governance
Artificial intelligence (AI) is rapidly influencing utilization management, clinical decision pathways, and quality workflows—areas CMS is increasingly regulating.
NCQA is embedding expectations for responsible AI directly into accreditation, including standards for transparency, governance, and monitoring. “We’re establishing expectations for AI governance, transparency, [and] ongoing monitoring… so these tools are used responsibly, safely and in ways that actually enhance clinical judgment and member outcomes,” Musser said.
This approach aligns with CMS’ evolving regulatory position, which is heavily focused on preventing algorithmic bias, ensuring automated decisions can be appealed, and requiring that prior authorization determinations can be explained.
Shared priority: Strengthening primary care foundations
While CMS’ Innovation Center and value‑based models have increasingly emphasized primary care transformation, NCQA is echoing that priority through pilots and accreditation reform.
Musser flagged the fragility of the primary care workforce as one of the most pressing national quality challenges: “I think something like 3 to 5 percent of expenditures go to primary care. I think that number needs to get to 10 to 15 percent. Primary care needs the respect that it deserves,” he said.
Harrington added that payment model fragmentation is particularly harmful to the independent and rural practices that serve hard‑to‑reach populations. “Margins are getting slimmer and slimmer… it’s not sustainable for providers or patients,” she said.
Both CMS and NCQA are doubling down on primary care as the foundation for quality improvement, population health management, and equitable outcomes.
Shared priority: Simplifying the patient experience
Finally, both organizations share a concern about the complexity patients face when navigating care. Harrington emphasized the disconnect between system design and actual patient needs:
“Even as someone with over 15 years in this space, I still can’t figure it out half the time,” she said.
For CMS, this has manifested in simplified coverage notices, streamlined appeals processes, and pushback on inappropriate prior authorization delays. For NCQA, it translates into updated accreditation standards focused on integrated care coordination, patient-centered goal-setting, and better member communication.