Get Ready for HEDIS Measurement Year 2026: Navigating Transformative Updates

Essential Steps for Health Plans to Prepare for the Next Era of Quality Measurement

The National Committee for Quality Assurance (NCQA) has outlined key proposals for HEDIS Measurement Year (MY) 2026, continuing its push toward a fully digital reporting framework by 2030. These changes reflect a commitment to improving healthcare quality measurement and addressing care disparities. For health plan executives, understanding and preparing for these shifts is critical—not only to maintain compliance but also to drive better health outcomes.

Below, we review the significant updates, explore steps payers can take to adapt to these changes, and show how Vital Data Technology's Affinite Quality Improvement solution can support this transition.

Proposed New HEDIS Measures for MY 2026

1. Follow-Up After Acute Care Visits for Asthma (AAF-E)

The AAF-E measure evaluates outpatient follow-up rates within 30 days of acute visits for asthma among members aged 5–64. This new measure replaces the current Asthma Medication Ratio (AMR) measure. By focusing on follow-up care, the goal is to improve asthma management and reduce exacerbations that lead to emergency care.

2. Tobacco Use Screening and Cessation Intervention (TSC-E)

TSC-E targets members aged 12 and older and measures the prevalence of tobacco screening and cessation support. The addition of this measure underlines the ongoing emphasis on preventive care and replaces the outdated Medical Assistance with Smoking and Tobacco Use Cessation (MSC) measure from Consumer Assessment of Healthcare Providers and Systems (CAHPS®).

3. Disability Description of Membership (DDM)

This innovative measure aims to collect standardized data on disability statuses for members aged 15 and above. The objective is to close care gaps for persons with disabilities by improving the availability and precision of membership data.

Changes to Existing Measures

Several existing HEDIS measures will undergo notable revisions in MY 2026, including technical updates, expanded age ranges, and shifts to Electronic Clinical Data Systems (ECDS) reporting. Key updates include the following:

• Social Need Screening and Intervention (SNS-E): Expanded data-capture methods with additional ICD-10 Z codes for identifying social needs.
• Lead Screening in Children (LSC-E): Transitioning fully to ECDS reporting while eliminating alternative administrative methods.
• Adult Immunization Status (AIS-E): Adding COVID-19 immunization as a core reporting component for adults aged 19 and older.

These updates emphasize NCQA’s broader strategy of integrating advanced data standards and improving health equity.

NCQA’s Digital Reporting Vision

The gradual transition from traditional administrative reporting to Electronic Clinical Data Systems (ECDS) reporting lies at the heart of these changes. By MY 2026, several measures will require ECDS reporting, such as Statin Therapy for Patients with Diabetes (SPD). Additional updates include aligning HEDIS race and ethnicity stratifications with new federal classifications to deliver more nuanced reporting.

NCQA’s digital-first approach holds immense potential—but for payers, this transformation often requires updates to data infrastructure, workflows, and technology partnerships. Achieving true digital measurement isn’t simply a matter of switching formats; it demands deep integration of real-time clinical data sources, scalable analytics, and secure systems capable of supporting new electronic standards and interoperability requirements.

For many health plans, this shift means reevaluating legacy platforms, increasing investments in data governance, and fostering closer collaboration among IT, quality, and clinical teams. Implementing sophisticated automation and advanced analytics becomes essential as digital reporting increases the volume and complexity of quality data. This evolution also creates opportunities to reduce administrative burden, accelerate compliance, and unlock richer population health insights that drive better member outcomes.

Success hinges on forming strategic relationships with technology partners who can provide end-to-end support for digital HEDIS measures—from seamless data aggregation to actionable reporting and continuous compliance monitoring. Proactive planning and investment now will ensure payers are well-positioned for the fully digital reporting landscape NCQA is building for the next generation of healthcare quality measurement.

Actionable Steps for Payers

With these proposed changes, health plans should begin preparing immediately to ensure compliance and operational efficiency. Here are three actionable steps health plan executives can take:

1. Review Current Quality Measurement Processes

Evaluate your organization’s ability to collect and report data for measures shifting to ECDS. Identify bottlenecks in interoperability or gaps in member data that could hinder compliance.

2. Engage in NCQA’s Public Comment Period

The public comment period provides an opportunity for payers to offer feedback on measure feasibility, relevance, and implementation. Participating in this process can ensure your voice is included during policy revisions. For MY 2026, the comment window remains open until March 13, 2025.

3. Evaluate Vendor Capabilities

With the increasing complexity of HEDIS standards, health plans must ensure their quality improvement vendors can support digital reporting needs. Evaluate current vendors to confirm they have the infrastructure, expertise, and advanced tools necessary to adapt to evolving requirements.

How Vital Data Technology Can Help

Choosing the right technology partner is more important than ever. Vital Data Technology's Affinitē Quality Improvement solution offers a robust platform designed to streamline HEDIS measurement and reporting, making it the perfect partner for navigating the MY 2026 updates.

With powerful analytics and automation capabilities, Affinitē QI helps health plans efficiently manage quality improvement activities, achieve higher compliance, and identify actionable insights to improve performance. Its end-to-end digital support ensures that your organization aligns seamlessly with NCQA’s digital reporting requirements, reducing manual effort and improving data accuracy.

By leveraging Affinitē QI now, health plans can future-proof their HEDIS operations and focus on enhancing member outcomes while maintaining regulatory compliance.

Preparing Now for a Digital Future

The proposed updates to HEDIS MY 2026 signal significant shifts in quality measurement. For payers, staying ahead means preparing now - auditing internal systems, engaging actively in NCQA’s updates, and investing in advanced vendor solutions like Affinitē.

By starting early, health plans will not only meet regulatory requirements but also play a role in driving innovation and higher standards in healthcare quality. Together, we can adapt to a digital-first future and create better outcomes for the members we serve.