“We have an enormous opportunity to continue to shift quality and performance measurement toward the things that people experience in their day-to-day lives and to empower patients to express what quality means to them,” says Dr. Vivek Garg, NCQA’s President and CEO. “Including person-centered outcome measures in HEDIS represents an important step forward, supporting health plans and care delivery organizations in focusing on what truly matters to patients.”

What Are PCO Measures?

NCQA developed the PCO measures to work in tandem with clinical care, helping older adults and other people living with complex care needs make progress toward a goal that matters most to them. The measures have gone through extensive testing and have been implemented with over 30,000 patients, 750 clinicians, 40 care delivery systems and 17 states.

The PCO measures fit within the broader context of an age-friendly health system because they focus on what matters to the individual and their family and caregivers, which is the “What Matters” of the 4M’s of age-friendly care.​

The PCO measures are approved for inclusion in HEDIS MY 2027 and will be reported using the Electronic Clinical Data Systems (ECDS) reporting method. The three measures are:

1. Goal Identification (GID-E). The percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal.
2. Goal Follow-up (GIF-E). The percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal and followed up on the goal.
3. Goal Achievement (GIA-E). The percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal and achieved the goal.

Note: GIA-E will remain in first-year reporting status for at least two years, so 2030 would be the earliest year for public reporting of this measure.

How Are PCO Measures Relevant to Special Needs Plans?

NCQA chose to implement PCO measures with special needs plans because of the close alignment with existing care delivery practices and the Model of Care required by the Centers for Medicare & Medicaid Services. We interviewed seven plans, including both C-SNP and D-SNP, to gather insights to inform the integration of PCO measures into HEDIS.

“Feedback from the plans was generally positive. The PCO approach aligns with the SNP mission to deliver person-centered care and existing workflows around goal setting and care plans,” says Daniela Lawton, NCQA’s Assistant Vice President of Quality Sciences Integration. “Some plans were concerned about the implementation timeline, potential burden on clinicians and the challenge of trying to contact all members for goal setting, and NCQA considered this feedback as we developed our strategy.”

Earlier this year, NCQA tested the PCO measures with two D-SNP plans to confirm that the measures are feasible, adaptable to diverse systems and capable of driving person-centered care. Read our blog, NCQA Tests Person-Centered Outcome Measures With D-SNP Plans, to learn more about the testing and get tips for how to implement the measures.

How Did NCQA Incorporate Public Comment Feedback?

Public comment is an important step in the process of adding new measures to HEDIS. NCQA received comments about the PCO measures from 91 individuals and organizations and the majority of comments were supportive. Positive comments cited that the measures capture meaningful outcomes, support whole-person care, align with existing policy requirements and fill a measurement gap for people with complex needs.

One area of concern relates to feasibility, data capture and interoperability challenges. That’s why NCQA co-developed the Person-Centered Outcome Implementation Guide to provide direction for reporting goals and the PCO measures using FHIR^® resources. It includes the steps to document goal-directed care, such as recording a goal, using goal attainment scaling or a patient-reported outcome measure to track goals over time and goal follow-up.

Another concern relates to the administrative burden of the measures—both on health plans and clinicians. The alignment between PCO measures and the CMS Model of Care is achieved by leveraging existing care management workflows and documentation processes wherever possible. NCQA’s testing with D-SNPs demonstrated that organizations can implement the measures without substantial burden. We also pushed back the potential to publicly report Goal Achievement (GIA-E) to no earlier than 2030 to allow plans time to focus on the process of setting standardized goals and following up on them.

“PCO measures have been tested a great deal and they’ve been tested successfully,” says Lawton. “We are excited to release them in HEDIS MY 2027 and we hope to expand implementation of the PCO measures for other populations, including people with behavioral health conditions.”

Learn More

Visit our website to learn more about the PCO measures and how to implement them in your organization.

Acknowledgements

NCQA developed person-centered outcome measures with support from The John A. Hartford Foundation, the SCAN Foundation and the Gordon and Betty Moore Foundation.

We appreciate support from corporations and foundations that share our values and are committed to advancing our mission to improve the quality of healthcare. For more information about partnership opportunities, please contact Erin Oganesian, Assistant Vice President, Quality Solutions Group at eoganesian@ncqa.org.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

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For HEDIS Measurement Year (MY) 2027, NCQA introduced several updates:

• Added 6 new measures.
• Updated 3 existing measures.
• Transitioned 1 measure to Electronic Clinical Data Systems (ECDS) reporting.
• Restructured ECDS-reported measures reorganized by clinical domain.
• Made minor adjustments made across multiple measures.

Now Open: HEDIS Public Comment on Measure Retirement

NCQA seeks feedback about the proposed retirement of select HEDIS measures for Measurement Year (MY) 2027. The ad hoc public comment period is open from August 3 to August 17. Read on to learn more about the measures proposed for retirement and visit our public comment webpage to submit your comments.

New HEDIS Measures

The newest additions to HEDIS address follow-up after a positive colorectal cancer screening, prenatal syphilis screenings, person-centered outcome goals and the use of continuous glucose monitoring.

Two Screening Measures

Follow-Up After Positive Colorectal Cancer Non-Invasive Screening Test (COF-E). The percentage of persons 45–75 years of age who received a colonoscopy for a positive colorectal cancer non-invasive screening test.

Intent: Timely follow-up after a positive non-invasive colorectal cancer screening test helps complete the screening process and supports earlier detection and treatment. Delays in follow-up can reduce the value of screening and postpone treatment, increasing both cancer risk and mortality.

• The United States Preventive Services Task Force (USPSTF) recommends colorectal cancer screening for adults aged 45–75 years using stool-based or visual-structural tests.
• Follow-up requirement. A positive non-invasive screening test requires a colonoscopy to complete the screening process.
• Clinical importance. Successful cancer prevention and detection depends on timely follow-up after abnormal screening results.

Prenatal Syphilis Screening (PSY-E). The percentage of deliveries that had a syphilis screening during the first trimester or within 14 days of the first pregnancy diagnosis or prenatal visit or within 30 days of enrollment in the organization.

Intent: Prenatal syphilis screening helps identify and treat infection early in pregnancy, reducing the risk of congenital syphilis in newborns.

• The USPSTF recommends screening pregnant individuals for syphilis early in pregnancy or at the first prenatal visit.
• Clinical rationale. Untreated syphilis acquired before or during pregnancy can lead to congenital syphilis, with a transmission frequency of up to 90%. (1)
• Public health trend. Syphilis rates in pregnancy have risen sharply: In 2024, 3,941 infants were born with congenital syphilis—a nearly 700% increase from 2015, when 495 cases were reported. (2)

Three Person-Centered Outcome Measures

Person-Centered Outcome—Goal Identification (GID-E).

Person-Centered Outcome—Goal Follow-Up (GIF-E).

Person-Centered Outcome—Goal Achievement (GIA-E).

These measures assess the percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal, followed up on the goal and achieved it. They are found under the care coordination subdomain and are specified for reporting by members enrolled in Special Needs Plans (D-SNP and C-SNP). This is the first year that HEDIS Volume 2 will include the person-centered outcome (PCO) measures.

Intent: The PCO measures help individuals and/or caregivers work with clinicians to identify, track and achieve meaningful, measurable goals that support care planning, quality improvement and clinician accountability.

• Care alignment. Person-centered outcomes support whole-person care by aligning care delivery with individual goals and preferences.
• Clinical value. Goal-based care helps clinicians understand the outcomes individuals value, along with their preferences regarding conditions, possible treatments and tradeoffs. (3,4)
• For additional information, refer to NCQA’s person-centered outcome measures resource page.

One Utilization Measure

Continuous Glucose Monitoring Utilization for Patients With Diabetes (CGD-E). The percentage of persons 18–75 years of age with diabetes on insulin therapy who have evidence of continuous glucose monitoring (CGM) utilization during the measurement period.

Intent: CGM supports diabetes management by helping individuals and clinicians identify glucose trends, respond to hypoglycemic and hyperglycemic events and reduce the risk of serious diabetes-related complications. This utilization measure provides transparency into CGM utilization patterns and may help stakeholders identify potential gaps in CGM use.

• The American Diabetes Association recommends CGM use at diabetes onset and throughout treatment for adults using insulin therapy. (5)
• Utilization gap. Despite these recommendations, CGM use remains low among recommended populations and varies across subpopulations and payers.

Changes to Existing HEDIS Measures

Pharmacotherapy Management of COPD Exacerbation (PCE). Updated the measure to assess the percentage of persons 40 years of age and older who had a chronic obstructive pulmonary disease (COPD) exacerbation during the measurement period and were dispensed appropriate COPD medications.

Intent: The PCE measure was updated to align with the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) pharmacotherapy recommendations for patients who experience COPD exacerbations.

• Denominator changes. The measure transitioned from an episode-based denominator to person-based (meaning a member can only be reported in the measure once). The denominator now counts the number of persons who had a qualifying COPD exacerbation event during the measurement period.
• Exclusion changes. The measure now has an exclusion for persons with a comorbid diagnosis of asthma. Clinical guidelines state that individuals with comorbid asthma and COPD should prioritize asthma treatment recommendations over COPD treatment.
• Numerator changes. The measure now looks for dispensing events of appropriate COPD medications during the measurement period. This includes the timeframe prior to the COPD exacerbation event identified in the denominator.

Note: The PCE measure will be in first-year status for MY 2027 due to changes made during the re-evaluation.

Adult Immunization Status (AIS-E). Updated the pneumococcal indicator denominator age range to 50 and older and added two new age stratifications (50–64 and total), which will be reported in addition to the current 65 and older stratification.

Emergency Department Utilization (EDU). Added the Medicaid product line for members 18–64 years of age.

Cross-Cutting Topics

Death Exclusion. Expanded the death exclusion criteria to include persons who died any time on or before the last day of the measurement period.

Changes to the Order of Measures. Removed the Measures Reported Using Electronic Clinical Data Systems domain. Measures from this domain are now located in clinically specific domains (for example, Breast Cancer Screening (BCS-E) is now found under the Prevention and Screening subdomain).  

Race and Ethnicity Stratification Reporting. Updated the race and ethnicity stratification categories and data element tables to capture declinations and unknown race and/or ethnicity more precisely.

Palliative Care Exclusion. Modified the value sets and codes used to identify this exclusion.

ECDS Reporting

NCQA will allow voluntary ECDS reporting for the Glycemic Status Assessment for Patients With Diabetes (GSD-E) measure. Click here for information about the transition to ECDS reporting.

Measures Under Consideration for Retirement in MY 2027 

NCQA is evolving HEDIS to better reflect where quality measurement is headed: toward a more focused, meaningful measure set that delivers clearer, more actionable signals and supports improvement in care, accountability and value across the healthcare system. Measure retirement is an important part of this ongoing curation work, helping ensure that HEDIS adapts to advances in evidence, clinical practice, data availability, policy priorities and stakeholder needs.

NCQA is evaluating the following measures for potential retirement as part of its ongoing measure curation process:

• Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC).
• Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD).
• Diagnosed Mental Health Disorders (DMH).
• Diagnosed Substance Use Disorders (DSU).
• Documented Assessment After Mammogram (DBM-E).
• Language Description of Membership (LDM).
• Oral Evaluation, Dental Services (OED).
• Risk of Continued Opioid Use (COU).
• Topical Fluoride for Children (TFC).
• Use of Opioids at High Dosage (HDO).

In HEDIS Volume 2, these measures are listed as “Pending Retirement” in the “What’s New in Volume 2” section and also alongside each measure name in the individual measure specification. The decision to retire these measures is not final and is pending an August 3–17 public comment period, followed by a Committee on Performance Measurement review in September. If approved, these measures will be removed from HEDIS MY 2027 Volume 2 during the March 2027 Technical Update.

New Specification Enhancements Coming for MY 2028

With the release of MY 2027 Volume 2, NCQA has released a memo introducing specification enhancements planned for MY 2028. Two example HEDIS measure specifications, Prenatal Syphilis Screening (PSY-E) and Colorectal Cancer Screening (COL-E), are included to show the planned enhancements. The enhancements clarify data source expectations and promote consistent translation of narrative specifications into computable logic, while preserving current reporting and audit practices. These improvements are a continuation of the HEDIS digital measurement transition that started with the release of the ECDS reporting method.

Learn More

Get the HEDIS MY 2027 Volume 2: Technical Specifications in the NCQA Store. The publication purchase will include the new specification enhancements memo and example measures.

Visit the Digital Quality Hub to learn about the transition to digital quality measurement.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

References

1. Pérez-Cavazos, Samantha, María Mayela Rodríguez-Saldívar, Abiel Homero Mascareñas-De los Santos, and José Iván Castillo-Bejarano. “Congenital Syphilis: The Irrevocable Burden of a Late Diagnosis.” Pediatrics & Neonatology 63 (3): 306–7. https://doi.org/10.1016/j.pedneo.2021.10.006.
2. Centers for Disease Control and Prevention. (2025). Sexually transmitted infections surveillance, 2024 (provisional).
3. Lenzen, S. A., Daniëls, R., van Bokhoven, M. A., van der Weijden, T., & Beurskens, A. (2017). Disentangling self-management goal setting and action planning: A scoping review. PLoS ONE, 12(11). https://doi.org/10.1371/journal.pone.0188822
4. Vermunt, N. P. C. A., Harmsen, M., Westert, G. P., Olde Rikkert, M. G. M., & Faber, M. J. (2017). Collaborative goal setting with elderly patients with chronic disease or multimorbidity: A systematic review. BMC Geriatrics, 17(1), 167. https://doi.org/10.1186/s12877-017-0534-0
5. American Diabetes Association. (2026). Continuous Glucose Monitors. https://diabetes.org/advocacy/cgm-continuous-glucose-monitors

The post HEDIS® MY 2027: What’s New, What’s Changed, What’s Retired appeared first on NCQA.

The HEDIS MY 2027 Technical Specifications for Long-Term Services and Supports Measures is a set of HEDIS measures designed to assess whether LTSS organizations are delivering high-quality, person-centered care.

The specifications include a set of four measures that evaluate the quality of assessment, care planning and care coordination for organizations providing LTSS. These measures facilitate the creation of performance standards, allow for comparison of LTSS quality across programs and establish national benchmarks. LTSS HEDIS measures are reported exclusively using the case management record review method.

Updates to LTSS HEDIS Measures for MY 2027

For HEDIS Measurement Year (MY) 2027, NCQA updated the sampling guidelines and the LTSS measure specification format.

In MY 2027, the guidelines for the case management record review method were updated to include instructions for reducing the sample size based on the prior year’s rate. As with HEDIS Volume 2 sampling, organizations may use a rate calculated from the prior year’s reported rate to determine the sample size.

The LTSS technical specifications have a new format that aligns with the Fast Healthcare Interoperability Resources (FHIR^®) data standard and is similar to current HEDIS ECDS reported measures. The new format gives users all the information they need to calculate a HEDIS measure, in addition to the following updates:

• Integration of the clinical evidence base and general guidelines, reducing the need to reference multiple resources.
• Addition of a “Systematic Sample” section.
• Adoption of new terms, for consistency with FHIR and to reflect how measures are used. For example:

• • Replaced “eligible population” with “initial population.”
  • Replaced “required exclusions” with “denominator exclusions.”
  • Replaced “measurement year” with “measurement period.”

We did not modify the measures’ intent or requirements. Changes should not affect performance results.

New HEDIS Reporting Requirements for Health Plans with LTSS Distinction

For Health Plan Accreditation surveys on or after July 1, 2027, under the Renewal Evaluation Option, NCQA will require organizations with LTSS Distinction to report the two HEDIS LTSS measures listed below annually. Measures will be reported for MY 2027, beginning in June 2028.

• LTSS Comprehensive Assessment and Update (LTSS-CAU).
• LTSS Comprehensive Care Plan and Update (LTSS-CPU).

Organizations must submit audited HEDIS results to NCQA each year by the reporting date in HEDIS Technical Specifications for Long-Term Services and Supports Measures.

Visit our website for more information about LTSS Distinction for Health Plans.

Learn More

• Get the HEDIS MY 2027 LTSS measures in the NCQA Store.
• Visit the Digital Quality Hub to learn about the transition to digital quality measurement.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

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“Credentialing is an important process to protect patient safety and prevent healthcare fraud, but we know there are bottlenecks in the process that can delay access to care,” says Tsveta Polhemus, NCQA’s Assistant Vice President of Product Management. “We are listening to the market and learning how we can evolve our programs while maintaining trust in the data.”

What Is the Credentialing Collaborative?

The Credentialing Collaborative is a group of leaders representing health plans, technology vendors, credentials verification organizations, data aggregators, care delivery and policy organizations that provide feedback on the current and future state of credentialing. The group held its first meeting in June, and two additional meetings are planned for later this year.

The Collaborative is focused on:

• Reducing inefficiencies in primary source verification and ongoing monitoring of practitioner credentials by building trust in technology and automation.
• Shifting toward continuous monitoring and exception-based review to enable a more efficient recredentialing process.
• Exploring governance and trust frameworks for shared credentialing models to enable safe, reliable reuse of data.
• Identifying criteria for trusted and approved sources of credentialing data to support less arduous credentialing across states.

“Credentialing data is extremely dynamic and there is an opportunity for error as it moves through the system,” says Polhemus. “In order to scale operations and maintain rigor, organizations need automation, especially for large national health plans or virtual care organizations with networks that span all 50 states.”

Feedback from the Credentialing Collaborative will help NCQA modernize its credentialing standards to reflect evolving care delivery models, workflows and technology.

What Has NCQA Learned So Far?

Participants emphasized that credentialing serves an essential purpose: ensuring providers are qualified, competent and safe to deliver care. At the same time, many acknowledged that today’s processes contain significant duplication, manual effort and administrative burden.

Importantly, participants do not view modernization as lowering standards. Instead, they see it as an opportunity to strengthen oversight and eliminate unnecessary work.

Here are some key themes that emerged from the discussion:

Continuous monitoring could transform recredentialing.

Many organizations already perform monthly or near-real-time monitoring of licenses, sanctions, exclusions and other credentialing elements. Participants suggested that continuous monitoring could lower the burden of recredentialing, while acknowledging that certain essential tasks would still be needed (e.g., provider attestations, disclosure questions, assessment of exceptions).

Trust and auditability are essential.

Participants agreed that technology-enabled credentialing processes must be transparent, reproducible and auditable, based on authoritative sources and supported by clear provenance and timestamps. They suggested that future standards should focus less on documenting individual human actions and more on demonstrating that systems and controls function reliably.

Technology requires human oversight.

Participants emphasized that technology should support—not replace—sound oversight. There was broad agreement that routine verification activities can increasingly be automated, while human expertise remains essential for evaluating exceptions, risks and complex situations.

Trusted sources reduce redundant verification activities.

Participants expressed strong interest in expanding the use of authoritative sources, aggregators and approved verification services. Many stakeholders suggested that greater clarity from NCQA regarding approved and equivalent sources and evaluation criteria could reduce confusion and drive broader adoption of modern verification methods.

Alignment promotes efficiency.

Participants highlighted the importance of industry alignment. Many noted that differences across organizations, states and regulatory programs significantly contribute to administrative complexity and provider burden. Greater consistency could help create a more efficient experience for healthcare organizations and practitioners.

Organizational readiness varies.

Organizations that perform credentialing differ in levels of digital readiness and access to technology. As credentialing standards evolve, NCQA needs to create a clear pathway for organizations to change—and allow sufficient time to do so.

What’s Next

Our June convening reinforced stakeholders’ commitment to building a credentialing ecosystem that is more efficient, trusted and responsive to the needs of today’s healthcare system. NCQA uses an evidence-based approach to develop and refine its standards, which includes thorough review and vetting by subject matter experts and public comment.

“These conversations are helping shape NCQA’s understanding of where the market sees opportunity for improvement and where there may be emerging consensus around future directions,” says Polhemus. “We are grateful to the organizations that shared their perspectives and look forward to continuing the dialogue in future collaborative sessions.”

Learn More

Listen to our recent podcast, Credentialing: The Unsung Hero of Healthcare Quality, to learn more about credentialing and its impact on access to care.

Sign up for our mailing list to stay up to date on the progress of the Credentialing Collaborative.

Thanks to Our Partners

NCQA appreciates the insights from the organizations participating in the Credentialing Collaborative.

• Aetna Better Health of Illinois (Medicaid)
• American Medical Association (AMA)
• AmeriHealth Caritas
• Andros Technologies Inc.
• Baton Health
• BlueCross BlueShield of North Carolina
• BlueCross BlueShield of Rhode Island
• BlueCross BlueShield of Tennessee
• Capital Health Plan
• Centene
• Certify
• CHG Healthcare
• Cigna
• Council for Affordable Quality Healthcare (CAQH)
• CoxHealth
• Doctors Healthcare Plans, Inc.
• EXLService Philippines, Inc.
• Federation of State Medical Boards
• Gemini Diversified Services, Inc.
• Greeley
• Health Choice Network
• Health Plan of San Mateo
• Humana
• Johns Hopkins Health Plans
• Kaiser Foundation Health Plan
• KFMC Health Improvement Partners
• Koehler Quality Group, LLC
• Martin’s Point Health Care
• Medical Associates Health Plans
• Medical Mutual of Ohio
• MemorialCare Select Health Plan
• Michigan Department of Health and Human Services
• Molina Healthcare
• MultiCare Health System
• Northwestern Medicine Physician Network
• PrimeWest Health
• Professional Credentials Exchange, Inc
• ProviderTrust
• Quest Analytics
• Regence
• Service Coordination Unlimited (SCU)
• South Texas Physician Alliance
• State of Michigan, Bureau of Specialty Behavioral Health Services
• TECQ Partners, Inc.
• Tenon Consulting Solutions
• The Noble Group
• Trinity Health Livonia Hospital
• UnitedHealth – Optum
• UnityPoint Health – Meriter Hospital
• University of Pittsburgh Medical Center (UPMC)
• University of Utah Health Plans
• Verifiable
• Verisys

The post NCQA Credentialing Collaborative Explores the Future of Credentialing appeared first on NCQA.

NCQA will seek feedback about the proposed retirement of select HEDIS measures for Measurement Year (MY) 2027. These proposed changes are intended to strengthen the HEDIS measure set by identifying measures that may no longer provide strong signals for quality improvement, benchmarking or accountability relative to the burden of continued reporting and maintenance.

The ad-hoc public comment period will be open from August 3 to August 17.

Why Are Measures Being Retired?

NCQA’s measure curation work is guided by a broader modernization strategy focused on advancing HEDIS measures that are meaningful, actionable and aligned with the future of healthcare quality measurement. NCQA evaluated existing measures to determine if updates, retirement or replacement were appropriate. Evaluation ensures HEDIS measures remain evidence-based, clinically meaningful and feasible to implement.

Measures considered for retirement may have limited impact on quality improvement, low actionability, small populations, consistently high performance with little variation, overlap with other measures, significant reporting burden relative to value or reduced alignment with evolving clinical guidelines.  Together, these considerations help ensure the HEDIS measure set remains meaningful, effective and aligned with the needs of the healthcare system.

Why Should You Comment?

NCQA measures are based on published clinical guidelines and best available evidence. As new evidence becomes available and the healthcare system evolves, we evaluate measures to determine when updates, retirement or replacement are appropriate using the process described above.

Public comment is an important part of maintaining the HEDIS measure set. NCQA reviews all comments received during the public comment process and presents results to advisory panels and to the NCQA Committee on Performance Measurement for deliberation. NCQA will communicate final determinations through established channels following completion of its review and approval process.

How Can You Comment?

Public comment will go live on Monday, August 3. We will post the link and more details on our public comment webpage.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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Earlier this year, NCQA launched our first product offering related to automated data quality assessment. We have been working with health IT vendors, health information exchanges and technology partners through a beta implementation program to test HEDIS^® Data Quality Specifications and emerging approaches to automated data quality assessment and validation.

This work is intended to support a future state in which data quality can be monitored continuously across the data lifecycle to transition away from PSV as a universal requirement for HEDIS reporting in MY 2027. As the organizations most affected by changes to HEDIS audit, validation and data confidence expectations, health plans play a critical role in helping define how the industry responsibly transitions to these new approaches.

That is why NCQA is launching a Health Plan Data Quality Convening to identify the operational realities, dependencies and safeguards needed to make this transition successful. Participants will play a critical role in defining the roadmap for the industry’s transition from current validation methods, such as PSV, to more automated, scalable approaches while maintaining trust in quality measurement and clinical data.

How the Data Quality Convening Works

The convening is intended to surface actionable insights that promote alignment across the industry and inform the roadmap for modernizing data validation and quality assurance.

Through facilitated, discussion-based sessions, organizations will share real-world experiences and collaborate to identify practical approaches that support more reliable, scalable and trusted data for quality measurement. The convening will:

• Explore what creates trust and reliability in digital quality data.
• Examine how continuous monitoring approaches could complement and ultimately replace retrospective validation models.
• Identify the operational, governance and ecosystem capabilities needed to support a reduction in PSV requirements.
• Inform a roadmap for how NCQA and the industry can responsibly transition to scalable, automated data quality monitoring.
• Help ensure future approaches reflect real-world health plan needs and constraints.

Participants will take part in three virtual sessions from August through November 2026, where they will share information about their organization’s approach to data quality. NCQA will treat all shared information as confidential.

Output of the Data Quality Convening

Insights from the convening, combined with results from ongoing beta testing of NCQA’s HEDIS Data Quality Specifications, will inform an industry roadmap that NCQA will publish later this year. The roadmap will outline how the industry can transition from retrospective validation to more continuous, automated data quality monitoring while maintaining trust and confidence in quality measurement.

How to Participate in the Convening

We are seeking participation from health plan leaders and subject matter experts involved in:

• Quality measurement, analytics and reporting.
• Data management, interoperability and implementation of Fast Healthcare Interoperability Resources (FHIR^®).
• Audit, primary source verification or validation.
• Clinical operations or related functions.

Participation will be limited to one primary representative per organization, with the option to designate an alternate representative.

Visit our website to learn more about the convening or to submit an application. Please email us if you have any questions about the convening or the application process.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

FHIR^® is a registered trademark of Health Level Seven International and its use does not constitute endorsement by HL7.

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NCQA is launching a Digital Health Engagement Accreditation program that establishes a common quality framework and clear expectations for digital health solutions, increasing trust between purchasers and vendors and facilitating the shift toward performance-based contracting.

“NCQA’s program is unique because it was co-developed with the ecosystem, including the technology vendors building these tools, the organizations such as health plans and employers who are buying them, and the patients who are using them,” says Mia Nievera, NCQA’s Director of Clinical Quality Informatics. “It allowed us to evaluate the technological capabilities and customer needs simultaneously.”

Grounded in Market Research

The program’s content was informed by robust customer and market engagement.

Working Group

NCQA convened a working group with over 30 industry leaders—digital solution vendors, health plans, health systems, employers and patients—to discuss best practices, current challenges and emerging opportunities related to digital health engagement solutions. The feedback from this group laid the foundation for our standards and measures.

Learning Collaborative

NCQA formed a learning collaborative with five data testing partners that performed end-to-end testing of measures and eight advisory partners representing purchasers and public agencies that rely on engagement data for decision-making. Our partners tested two measures—goal setting and goal attainment—as potential measures of meaningful engagement with digital health solutions.

“One of the key takeaways from the learning collaborative is that the data structure is highly variable in terms of the types of data being collected, how those data are exchanged and stored, and how organizations are leveraging AI to manage the data,” says Nievera. “Our testing results reinforced the need for a measurement approach that standardizes key engagement signals and how populations are defined, while remaining flexible enough to accommodate different program designs.”

Public Comment

NCQA received over 1,400 comments, primarily from wellness and condition management vendors, digital health companies, care delivery and other organizations. Overall, the feedback was positive, with respondents citing benefits such as standardized quality expectations for digital health, increased credibility with purchasers, alignment with evidence-based practices and clearer differentiation across vendors.

“While the majority of the responses were positive, public comment also emphasized the need for greater flexibility to account for diverse business models, scopes of service and levels of data access,” says Jeni Soucie, NCQA’s Senior Manager of Product Management. “Organizations also expressed strong support for a ‘structured flexibility’ model that allows organizations to define their own measures within NCQA guardrails.”

What We Learned

Several key themes emerged from our research and were addressed in the program design:

• Engagement is more than enrollment or goal setting. Meaningful engagement is reflected through behavioral change, goal attainment and consistent interaction with digital health tools.
• Digital tools must adapt to diverse patient needs. That means incorporating social determinants of health concepts, including Food is Medicine approaches, and recognizing how caregivers can support members on their health journey.
• A standardized measurement framework is essential. Without a common performance yardstick, it is difficult to assess whether reported improvements reflect true program impact or differences in measurement approaches.
• Data gaps must be addressed. Organizations must continue to invest in structured data capture and in improving data accessibility for quality reporting. The industry also needs to align on minimum data expectations.
• Tools should be integrated into routine care delivery. Care teams should have access to the information collected through apps and devices, enabling clinical support and ongoing monitoring.
• AI presents both opportunities and risks. Guardrails are needed to facilitate responsible integration of AI-enabled tools and workflows.
• Privacy protections are foundational. Patients need to understand where their personal health information is stored, how it is used and what steps are taken to secure it.

About Digital Health Engagement Accreditation

NCQA’s new Digital Health Engagement Accreditation is a 3-year Accreditation for digital tools and applications. The program includes Core Standards and two modules, Health Assessment and Digitally Enabled Interventions. Organizations may participate in one or both modules.

The program includes two types of measures:

1. NCQA‑defined, standardized measures. Consistent specifications and reporting structures to produce comparable data across organizations.
2. Organization‑defined measures. Recognizing the diversity of program goals and outcomes, organizations are given flexibility to define additional measures by using a standardized NCQA template.

This measurement strategy is grounded in real‑world program behavior and supports meaningful evaluation, continuous improvement and an impact on outcomes.

“We’re excited to bring this new program to the market to define what high-quality digital health solutions look like and to help bridge the gap between technology vendors and purchasers,” says Soucie. “It will help vendors demonstrate that they deliver value in quality terms that are meaningful to purchasers and it will facilitate the shift to performance-based contracting.”

Learn More

• Register for our webinar, Digital Health That Delivers: Driving Engagement and Value, on June 30 at 1:00 p.m. (ET).
• Listen to our podcast, Beyond the App: What Meaningful Digital Engagement Really Looks Like.
• Purchase the Digital Health Engagement Accreditation standards in the NCQA Store starting on June 30.

NCQA is also developing a digital health solutions playbook for purchasers. If you would like to learn more or get involved, please email us.

Join Our Early Adopter Cohort

We are accepting applications for our Digital Health Engagement Early Adopter Cohort. This complimentary cohort is designed for organizations that are new to NCQA Accreditation and are committed to building the quality, measurement and governance capabilities needed to demonstrate program performance and outcomes. Through a combination of expert guidance, educational resources, structured touchpoints and peer learning opportunities, participants will receive support throughout their Accreditation journey.

Complete an interest form here. NCQA will reach out to confirm your eligibility and provide the next steps.

The post NCQA Launches Digital Health Engagement Accreditation Program appeared first on NCQA.

Read on for key insights from the discussion.

Rural Health Access Remains the Defining Challenge

In Nevada, geography is more than a backdrop—it shapes access to care. Communities are spread across vast, sparsely populated areas and infrastructure gaps create significant barriers.

The state’s 14 rural hospitals span 16 counties, with many designated as critical access facilities. Some communities are so remote that patients rely on helicopter transport. These challenges reflect more than distance; they point to a system not designed to meet rural needs.

That is something Assemblywoman Brown-May is hoping to change.

Nevada’s Rural Health Transformation effort emphasizes flexibility. The state is organizing investments across four areas: flexible infrastructure, workforce development, rural health outcomes and innovation and technology. But rather than dictating solutions from the top down, the state is engaging providers across the care continuum—hospitals, clinics, dentists and behavioral health organizations—to identify what their communities need most.

Brown-May also emphasized that Nevada is prioritizing investments that create lasting infrastructure and sustainable solutions, not short-term fixes.

Disability Inclusion Improves Health Systems for Everyone

Disability inclusion is a core focus of Brown-May’s work, with implications far beyond any single population. About one in four Americans has a disability, yet health systems still often overlook accessibility, communication needs and individualized care.

Brown-May underscored a key principle: when systems are designed for people with disabilities, they work better for everyone. From curb cuts that support both wheelchair users and families with strollers, to digital tools that enhance communication and independence, accessibility innovations ultimately become universal improvements.

Equally important is reframing how disability is understood in policy. “When you’ve met one person with a disability, you’ve met one person,” she said, stressing the importance of flexible, person-centered approaches rather than one-size-fits-all solutions.

Interoperability: Connected Data Enables Better Care

Like many states, Nevada is still working toward a fully integrated health information exchange. Today, health data often resides in disconnected systems, leaving patients and providers to fill in the gaps.

Brown‑May shared a personal story in which, after receiving emergency care while traveling in state, her follow-up provider could not access her test results. Without her manual intervention, the system would have duplicated tests, resulting in increased costs and delayed care.

The assemblywoman stressed that this is not an isolated experience—it is a systemic issue. Without interoperability, care is less efficient, more costly and patients bear the burden of coordination. At the same time, expanding data sharing requires careful consideration of trust, governance and privacy protections.

Sustainable Health Transformation Requires Strong Collaboration Across Government

Sustained health system change depends on strong partnerships and shared accountability across government. As Brown-May noted, improving care requires alignment among policymakers, state agencies, providers and communities.

In Nevada, collaboration is taking shape through coordination between the legislature, Medicaid and the state’s new Health Authority. Importantly, this work also extends beyond political lines.

Brown‑May’s parting message emphasized that effective policy centers on serving people. “We’re all on the same team… we’re all working to build a policy that affects everyone.”

NCQA thanks Assemblywoman Tracy Brown-May for sharing her time and thoughtful insights with our audience.

Visit our video gallery to watch the full Fireside Chat recording. 

The post NCQA Fireside Chat: Nevada’s Approach to Sustainable, People-Centered Health Policy appeared first on NCQA.

A new resource, Cracking the Code: A Health Equity Analytics Implementation Playbook for Healthcare Organizations, helps answer that question. The playbook offers a structured, practical approach for using advanced analytics to identify disparities, measure improvement and guide action.

The playbook is designed primarily for quality improvement leaders in health plans and health systems who are working to advance health equity. More specifically, it is intended for professionals responsible for:

• Population health strategy.
• Quality improvement initiatives.
• Data analytics and reporting.
• Health equity program design.

Policymakers and regional collaboratives aiming to establish shared benchmarks and promote collective accountability among organizations serving the same populations will also find this playbook valuable.

What Are Advanced Health Equity Analytics Methods?

Advanced health equity analytics methods are a tool to evaluate performance across multiple quality measures and multiple stratified subgroups simultaneously, revealing patterns that are otherwise difficult to detect. These methods produce health equity scores that healthcare organizations can use to monitor reductions in disparities, quantify the impact of interventions and benchmark performance for system-wide accountability.

NCQA assessed the validity, utility and feasibility of four advanced health equity analytic methods using real-world data from two health plans and one health system. We combined this data evaluation with detailed interviews and group discussions to understand how these scores could be implemented in practice to support quality improvement and population health strategies.

The resulting Implementation Playbook presents a detailed approach for:

• Selecting and building a health equity scoring method that works for your organization.
• Mobilizing internal support and resources.
• Gathering external buy-in across organizations to collectively address health gaps across overlapping populations.

Many organizations already track quality performance—but often in ways that miss the full picture. Evaluating measures in isolation, or stratifying by a single factor at a time, can overlook how disparities intersect and compound across populations. The playbook addresses this challenge by promoting a more holistic approach and providing a pathway to get there.

How Can Organizations Use the Implementation Playbook?

Organizations can use the playbook at different stages of their health equity journey. For those just getting started, it provides a phased approach that begins with simple measure stratification and builds toward more advanced composite scoring. For organizations with more mature analytics capabilities, the playbook offers guidance on refining methods, scaling efforts and aligning with external partners.

To build a health equity scoring approach, an organization must consider the following steps:

1. Select a quality measurement focus area.
2. Choose which demographic factors to analyze.
3. Identify reference groups and comparison points.
4. Interpret the results.

Compiling and analyzing the data requires organizations to have adequate internal staff capacity, typically comprised of specialized staff who are well-versed in robust analyses and data systems. Once the data for health equity scores are retrieved, they can be integrated into existing internal reporting methods or dashboards.

These scores can enable comparisons within and among healthcare organizations, helping them gain a better understanding of their impact across populations. The scores can also guide program implementation efforts to improve health equity across different populations.

Learn More

Visit our website to download a copy of Cracking the Code: A Health Equity Analytics Implementation Playbook for Healthcare Organizations.

This playbook is part of a broader effort to close gaps in care through measurement and incentives. Join us for a webinar, Beyond Measurement: Turning Health Equity Insights Into Action, hosted by the Commonwealth Fund and the California Health Care Foundation on June 30 at 3:30 pm (ET), to learn more about this work and other health equity accountability initiatives.

Feedback from Participating Organizations

Here’s what we heard from organizations that participated in the testing:

“Part of my work here is to help educate top down around equity . . . with our members and the different disparities that we observe. I can’t do that without solid data . . . and predictive analytics and identification of trends. Where are those hotspots? Where should we deploy resources or limit resources?” ~ Vice President of Health Equity

“Oftentimes we collect a great amount of information and data from multiple sources. [Making] sense of multiple data sources and multiple data outputs, such as four distinct numeric outputs of equity . . . allow organizations to have conversations around this.” ~ Community Health Impact Manager

“[These] methodologies gave us an opportunity to compare equity scores among our three biggest Medicaid markets for our plan. We… sometimes compare performances between different markets, but we never really looked at health equity that way.” – Senior Director for Quality Analytics

Acknowledgements

This work is supported by the California Health Care Foundation and the Commonwealth Fund.

The post Turning Data Into Action: A Playbook for Advancing Health Equity appeared first on NCQA.

About NCQA’s Public Comment

NCQA releases program updates for public comment to generate thoughtful feedback and suggestions from interested parties. Many comments lead to updates to our standards and policies, strengthening them for all stakeholders. NCQA asks respondents to evaluate whether the proposed requirements are feasible as written and clearly articulated, and to identify areas that may need clarification.

Summary of Proposed Changes

Below is a summary of the proposed changes to NCQA’s programs and standards. You can review the full details on NCQA’s website.

New Accreditation Program for Advanced Primary Care

NCQA developed Advanced Primary Care Accreditation in response to evolving expectations for how primary care is delivered, financed and evaluated across the healthcare landscape. It reinforces the shift toward payment models that reward longitudinal, coordinated, team-based care management.

The program builds on NCQA’s Patient-Centered Medical Home Recognition by incorporating enhanced capabilities, greater accountability and improved infrastructure. Program standards proposed for public comment are organized into six domains:

• Population Health Management.
• Coordinated, Team-Based Care.
• Patient Safety and Experience.
• Behavioral Health.
• Clinical Quality.
• Data Management and Exchange.

The program also includes a quality measure bundle designed to balance near-term feasibility with long-term innovation. Established electronic clinical quality measures (eCQM) that many organizations already collect and report are used to assess current performance, while separate utilization reporting requirements provide insight into care delivery patterns. A limited set of FHIR^®-enabled digital quality measures (dQM) signals future expectations and offers a clear roadmap for advancing digital quality reporting over time.

This Accreditation was developed with extensive market engagement, feedback from advisory groups and a pilot program that offered real-world insights across diverse primary care delivery models.

The program will be released in November 2026, with survey availability beginning in July 2027.

Proposed Health Plan Accreditation Update

NCQA proposes updates to the 2027 Health Plan Accreditation to reduce administrative burden, streamline evidence expectations and encourage continued alignment with external regulatory requirements, while continuing to support meaningful evaluation of health plan performance.

Proposed updates include:

• A focused set of requirement reductions and refinements to streamline the program and reduce administrative burden, particularly for Renewal Surveys.
• Clarifications to improve consistency and usability of requirements.
• A new requirement addressing oversight of AI-generated outputs within the Utilization Management domain.

These changes represent a targeted, evidence-based step toward a more streamlined and modernized Health Plan Accreditation program.

How to Participate in Public Comment

Visit My NCQA to submit comments through our new and improved public comment process.

The public comment period ends at 11:59 p.m. (ET) on Friday, July 10. For details on proposed changes, visit the NCQA website.

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

The post Public Comment Is Open! Share Your Feedback on a New Accreditation for Advanced Primary Care and Updates to Health Plan Accreditation appeared first on NCQA.