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.

Watch for an invitation to join our Early Adopter cohort coming soon!

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.

Across the industry, initial efforts have focused on defining governance principles and foundational controls for responsible AI use. The next challenge is translating those principles into complex workflows while measuring the impact on quality, outcomes and experience.

To support healthcare organizations in navigating this transformation, NCQA is launching an AI Learning Collaborative, with our first use case focused on prior authorization. Building on conversations from NCQA’s prior AI convenings, the Learning Collaborative provides a structured, in-depth engagement model designed to support implementation and evaluate outcomes at the workflow level.

Responsible Use of AI in Prior Authorization

Prior authorization represents a high-risk area for AI adoption given its complexity, visibility and direct patient impact. While AI offers meaningful opportunities to improve efficiency and turnaround time, it also raises important questions about transparency, process integration and measurable outcomes.

This Learning Collaborative is timely, as organizations prepare to implement the CMS Interoperability and Prior Authorization Final Rule (CMS-0057), which focuses on reducing friction for clinicians and patients, improving information exchange and demonstrating explainable, timely decisions.

How the Learning Collaborative Works

The Learning Collaborative is a fee-based experience designed to help you learn from peers, engage with national experts and develop best practices for responsible AI implementation and impact evaluation. Participants will:

• Engage in peer learning on real-world AI implementation.
• Strengthen governance, accountability and outcomes measurement frameworks for specific use cases.
• Share anonymized outcomes metrics and evaluate implementation effectiveness and variances against peers.
• Contribute to and access evolving, use-case-specific implementation playbooks and outcomes-monitoring frameworks.

Benefits of Participating in the AI Learning Collaborative

NCQA’s AI Learning Collaborative is designed to support organizations across the maturity spectrum, offering both foundational guidance and opportunities to validate and optimize existing strategies. Participating organizations can:

• Shape emerging industry best practices.
• Accelerate AI innovation responsibly.
• Develop new metrics and evaluation methods within workflows.
• Align with regulatory expectations, including CMS-0057 and state-specific requirements.
• Build public trust by promoting transparency and accountability.

Join Us!

Visit our website to learn more about the AI Learning Collaborative and find out how your organization can participate.

The post Shape the Future of AI in Prior Authorization: Apply to Join NCQA’s Learning Collaborative appeared first on NCQA.

The Problem: Fragmented, Manual and Inconsistent Data Exchange

Quality measurement has historically depended on manual chart reviews, point-to-point interfaces and inconsistent data feeds, resulting in administrative burden and delays in Healthcare Effectiveness Data and Information Set (HEDIS^®) reporting. As organizations transition toward digital quality measurement, retrieving accurate and complete patient rosters across organizational boundaries remains operationally complex.

While Fast Healthcare Interoperability Resources (FHIR^®) is recognized as the industry standard for exchanging healthcare data, adoption remains inconsistent. EHR infrastructure is typically optimized for one-at-a-time patient retrieval, so scaling to thousands of members introduces performance constraints. And many HEDIS-certified vendors do not yet accept FHIR-native inputs, requiring additional mapping from FHIR resources into proprietary vendor formats for HEDIS reporting.

The Solution: Moving Toward Adoption of Bulk FHIR

NCQA convened the Bulk FHIR Quality Coalition to perform real-world testing of data exchange using interoperable data formats at scale and to evaluate the quality of FHIR data. Cambria, MultiCare and eHealth Exchange were the first cohort of organizations to participate in the coalition.

Using a secure, Trusted Exchange Framework and Common Agreement (TEFCA™)-aligned network and a single connection between organizations, the teams built and tested systems that could exchange large volumes of standardized clinical data for quality reporting.

Each organization had a specific role:

• NCQA provided access to Digital HEDIS FHIR Implementation Guides and a sample of HEDIS measures codified in Clinical Quality Language.
• eHealth Exchange served as the interoperability intermediary, architecting a single-connection model that eliminated bespoke point-to-point integrations, enabling MultiCare and Cambria to transact Bulk FHIR data within a TEFCA-aligned trust framework.
• MultiCare implemented a production-grade Bulk FHIR endpoint within their Azure API and Epic ecosystem and leveraged a cloud-enabled data repository to support high-volume export requests.
• Cambria generated fully attributed member rosters, initiated Bulk FHIR export requests, built ingestion pipelines to retrieve the data, validated data completeness and mapped standardized FHIR outputs into its HEDIS-certified vendor’s proprietary calculation environment for reporting.

Results

The collaboration showed that regulated APIs and shared FHIR profiles can operate consistently at scale when supported by governance, attribution standards and data quality validation.

• Cambia and MultiCare successfully exchanged HEDIS-relevant clinical data for over 5,000 attributed members, validating data completeness for quality reporting.
• MultiCare reduced chart-chasing costs by approximately $50 per chart and improved medical record procurement performance by 175% compared to baseline manual workflows.
• Automated polling and retrieval reduced bulk export timelines from days or weeks to minutes, significantly accelerating quality reporting cycles.

Learn More

Read the full case study, Operationalizing Bulk FHIR for Scalable Quality Measurement.

Visit NCQA’s Digital Quality Hub for information and resources to support the transition to digital quality measurement.

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

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

The post NCQA Receives KLAS Points of Light Award for Demonstrating the Feasibility of Bulk FHIR Exchange appeared first on NCQA.

The ARM is an opportunity for NCQA to share our research and perspectives on the healthcare system and engage in meaningful conversations about emerging research and innovations. This year, we will be participating in a panel discussion and two poster presentations.

Panel Presentation

NCQA’s President and CEO, Dr. Vivek Garg, will participate on a panel titled “Great Debates: Quality Measurement and Prior Authorization.” This discussion will examine these two key pillars of U.S. healthcare policy that are currently under intense scrutiny. National experts will debate whether these systems require evolution, revolution or elimination.

Poster Sessions

NCQA staff will share their research in two poster presentations.

Assessing Data Feasibility for Intimate Partner Violence Quality Measurement: Results from Two U.S. Health Plans. This study evaluates the feasibility of a proposed HEDIS^® measure related to intimate partner violence by testing the measure with two health plans.

Authors: Yuzu Saito Butler, Polina Lissin, Kaila Boyd, Adrianna Nava

Real World Evaluation of Methods for Measuring Equitable Quality of Care: Quantitative Findings and Qualitative Insights. This study evaluates four published approaches for building combined health equity scores that consider multiple factors and measures simultaneously in real-world settings.

Authors: Crysta Meekins, Rachel Harrington, Yazhini Ramesh, Polina Lissin, Shawn Trivette, Alana Burke

This work is supported by the California Health Care Foundation and the Commonwealth Fund. Learn more about Putting Advanced Health Equity Analytics Methods into Practice.

Join Us in Seattle

If you would like to see our presentations in person, register for the 2026 AcademyHealth ARM. We hope to see you there!

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

The post NCQA President Will Participate in a “Great Debate” at the AcademyHealth Annual Research Meeting appeared first on NCQA.

To better understand how health plans can meaningfully reduce their climate impact, NCQA conducted new research to identify practical, evidence-informed strategies that health plans can implement today, even in a shifting policy environment.

Why We Did This Research

Existing research on healthcare decarbonization has largely centered on delivery systems, highlighting strategies such as care coordination, appropriate prescribing, telemedicine and avoiding unnecessary testing. These efforts matter—and the rapid expansion of virtual care during the COVID‑19 pandemic demonstrated real climate benefits. For example, one California health system avoided an estimated 17,000 metric tons of GHG emissions over three years by increasing virtual visits.

What has been missing is a comparable focus on health plans. Health plans influence care delivery through benefit design, provider contracting, network management and investment decisions. Yet there is limited guidance on where plans should start, which strategies are most feasible and how sustainability efforts can align with existing quality and performance goals. Our study was designed to help fill that gap.

How the Study Worked

NCQA used a structured, consensus-building research method to identify leading decarbonization strategies for health plans. We brought together health plan leaders from across the U.S., representing commercial, Medicare, Medicaid and Exchange lines of business, as well as both for-profit and not-for-profit organizations. Between August and October 2024, participants completed two surveys and joined a panel discussion that was convened between the two survey rounds.

Participants evaluated 29 potential decarbonization strategies across three criteria:

• How critical the strategy is for reducing emissions.
• Whether health plans can realistically use the strategy.
• Whether the strategy can be implemented without undue burden.

This approach allowed us to move beyond theory and focus on strategies that health plan leaders see as actionable in real‑world operations.

Key Insights

Three themes emerged consistently across the two surveys and the panel discussion.

Climate progress depends on the broader policy environment—but plans do not have to wait.

Participants were clear that government leadership and national climate narratives influence how quickly organizations act. At the same time, there was strong agreement that health plans can—and should—take action within their control, regardless of shifting federal priorities.

Strategies within a plan’s direct control rise to the top.

The highest‑rated strategies focused on areas that health plans directly own or manage, especially facilities, energy use and internal governance. These areas allow plans to act, measure progress and demonstrate impact without relying on external partners.

Climate action gains traction when aligned with quality goals.

When sustainability strategies align with goals that health plans already prioritize—such as access, efficiency, equity and affordability—they are more likely to be adopted and sustained. Telemedicine emerged as a strong example because it reduces emissions while improving access to care.

The Most Actionable Strategies for Health Plans

Participants identified seven priority strategies for health plans:

• Appointing a dedicated sustainability officer or team.
• Integrating climate considerations into strategic planning and forecasting.
• Investing in energy‑efficient lighting, heating, cooling and equipment in plan‑owned or controlled buildings.
• Electrifying building systems where feasible.
• Increasing use of renewable energy at plan facilities.
• Measuring and tracking Scope 2 emissions (energy-related emissions).
• Supporting government accountability mechanisms for emissions reporting.

For health plans, the takeaway is clear: you do not need to solve everything at once. By focusing on high‑impact, controllable strategies, health plans can make meaningful progress today and help shape a more sustainable healthcare system for the future.

Learn More

Read the full study, Top Consensus-Based Strategies for Health Plan Decarbonization: A Modified Delphi Study, published in the Journal of Climate Change and Health, here: https://www.sciencedirect.com/science/article/pii/S2667278225001385.

Acknowledgements

This research was made possible with support from the Commonwealth Fund (Grant Number 23-23436, 2023-2025).

The post New NCQA Research: What Health Plan Leaders Can Do to Reduce Climate Impact appeared first on NCQA.

Why is the HEDIS Technical Update Important?

HEDIS is a set of standardized performance measures that enable consumers, purchasers and policymakers to compare the performance of healthcare organizations. NCQA publishes HEDIS Volume 2 in August of the year prior to each measurement year. The Technical Update helps ensure that:

• Organizations have access to the most up-to-date technical guidance needed to implement HEDIS measures accurately and consistently.
• Coding resources, such as value sets and medication lists, are up to date.
• Any necessary changes are made in response to the evolving healthcare and policy environment.

The Technical Update was sent to all purchasers of the HEDIS MY 2026 Volume 2: Technical Specifications, and a release letter was posted to the HEDIS website on March 31.

What Is Included in the Technical Update?

The Technical Update includes:

• A re-released full-text HEDIS MY 2026 Volume 2 publication with edits in red text.
• Updated HEDIS MY 2026 Medication List Directory.
• Updated HEDIS MY 2026 Value Set Directory.
• HEDIS MY 2026 Risk Adjustment Tables.
• HEDIS MY 2026 Audit Timeline.

NCQA released four new measure-specific risk adjustment tables for MY 2026 and updated the shared risk-adjusted table. Read our blog, HEDIS Risk-Adjusted Utilization Tables: New Measures, Shared Table Updates and FAQs, for more information regarding these changes.

Changes in the Technical Update

Below are some highlights included in the Technical Update; this is not an exhaustive list.

Social Need Screening and Intervention (SNS-E)

• Removed ICD-10 diagnosis codes from the intervention denominators.

Rationale: ICD‑10 diagnosis codes can no longer be reliably linked to documented social determinants of health (SDOH) assessments. The measure will continue to rely on LOINC codes to capture standardized screenings and positive screening results.

• Removed SDOH assessment G codes from the screening numerators.

Rationale: HCPCS G0136 no longer aligns with SDOH screening activities included in the measure following the change in the CY 2026 Medicare Physician Fee Schedule.

• Added a Food Insecurity Screening Item Response Exception for the PRAPARE^® tool.

Rationale: Clarified that because of the structure of screening item LOINC 93031-3, a null result is considered a valid response to this question.

Read our blog, Social Need Screening and Intervention: What’s Changing in the MY 2026 Technical Update, for more details about these changes.

Tobacco Use Screening and Cessation Intervention (TSC-E)

• Updated the age criteria to identify the person’s age as of 180 days prior to the measurement period.

Rationale: Updated the measure to align with current age criteria for FDA-approved tobacco cessation medications.

Race and Ethnicity Stratification

• Updated references from “Some Other Race” to “Other Race” in the Race and Ethnicity Stratification general guideline and in each applicable measure specification.

Rationale: Updated to align with the U.S. Core Version 6.1.0 Model Definitions.

Learn More

If you have not  already purchased the HEDIS MY 2026 Volume 2: Technical Specifications, you can order the publication in the NCQA Store and you will automatically receive the Technical Update with your purchase.

Join the HEDIS Users Group to get timely guidance, expert clarifications and practical support directly from NCQA. You will gain access to exclusive webinars, resources and a collaborative community designed to help you confidently navigate HEDIS updates and reporting throughout the year. Visit our website to learn more.

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

PREPARE^® is a registered trademark of the National Association of Community Health Centers (NACHC).

The post NCQA Releases HEDIS® MY 2026 Volume 2 Technical Update appeared first on NCQA.

“People with behavioral health conditions tend to have more medical health issues,” says Vivek Garg, MD, MBA, President and CEO of NCQA. “If you have medical health issues and you have poorly supported mental health issues, the medical issues get worse. We’ve gained clarity as a country that this issue affects all of us.”

A New Partnership to Drive Industry Alignment

To address these challenges, NCQA and West Health recently announced a strategic partnership to advance the integration of behavioral health into primary care. The collaboration combines NCQA’s leadership in quality measurement and accountability with West Health’s expertise in care delivery innovation to identify and test a core set of behavioral health quality measures in real‑world settings.

The initiative also includes the formation of a policy solutions coalition as well as payer workgroups to align with state and federal policy initiatives and ongoing advocacy for behavioral health integration.

Improving outcomes will require more than isolated initiatives or one‑off interventions. Sustainable progress depends on alignment across policy, payment, technology and clinical practice, supported by measurement approaches that reflect real‑world care delivery and enable continuous improvement.

“Heroics aren’t going to change the health of our population,” says Dr. Garg. “That is not systematic, and that is not scalable.”

Measurement Gaps Undermine Behavioral Health Integration

Although there is broad agreement that integrating behavioral health into primary care improves outcomes, the field still lacks consensus on how to define and measure high-quality integration. Measurement gaps have made it harder for payers, policymakers and providers to align around shared expectations, creating barriers to scaling models that are proven to work.

Existing measures are often fragmented, overly complex or disconnected from clinical workflows—particularly in primary care settings already strained by workforce shortages, evolving digital requirements and uneven EHR capabilities. Without a clear, usable measurement framework, efforts to improve behavioral health outcomes remain difficult to sustain.

Convening National Leaders: The Advancing Behavioral Health Executive Forum

On April 21, NCQA and West Health convened national leaders from payer organizations, policymaking bodies and health systems in Encinitas, CA, for an Advancing Behavioral Health Executive Forum.

Discussions examined the disconnect between clinician‑driven, measurement‑based care and the process‑heavy metrics often tied to payment and accountability, underscoring the need for stronger alignment across policy, payment technology and clinical practice to support earlier identification and more consistent follow‑up in primary care.

The Forum featured a fireside chat between Dr. Garg and Zia Agha, MD, Chief Medical Officer at West Health Institute, who explored the real‑world barriers to integrating behavioral health into primary care and the system‑level changes needed to move from measurement to system-wide impact.

Moving From Measurement to Better Outcomes

Forum participants emphasized that reducing complexity is essential to driving improvement. The goal is not more measurement—but better measurement that supports clinical decision-making, reduces burden and enables learning over time.

“If you just measure and don’t provide the resources to fill those gaps, we often see resistance,” says Dr. Agha. “The beauty of the integrated care model is that it does make those resource changes in primary care.”

NCQA and West Health will continue working with stakeholders to advance scalable, measurement‑informed approaches that strengthen behavioral health integration in primary care.

Visit our website to learn more and stay updated on this work.

The post Advancing Behavioral Health Integration in Primary Care: Turning Shared Priorities Into Action appeared first on NCQA.