Digital Quality Measures – What to Expect for MY2026 and Beyond

The National Committee for Quality Assurance (NCQA) has released preliminary HEDIS Technical Specifications for Measurement Year 2026 (MY2026). These changes aim to promote transparency, accountability and continuous improvement in the healthcare system. In this fifth blog in our series, we will explore the new Electronic Clinical Data Systems (ECDS) measures, the transition of traditional measures to ECDS and other updates for MY2026.

New ECDS Measures

NCQA continues to focus on preventive and coordinated care by introducing two new ECDS measures that prioritize timely follow-up and evidence-based interventions for chronic conditions like asthma and tobacco use. These topics are consistent with national healthcare priorities and the ongoing trend emphasizing preventive care, patient engagement and coordinated management of chronic conditions.

1. The first measure is Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E). This measure assesses the percentage of persons 5-64 years of age with an urgent care visit, acute inpatient discharge, observation stay discharge or ED visit with a diagnosis of asthma that had a corresponding outpatient follow-up visit with a diagnosis of asthma within 30 days.
   
   The AAF-E measure incentivizes timely follow-up care for patients with asthma exacerbations, promoting better disease management and reduced hospital readmissions. The measure focuses on asthma management in primary care settings, where providers can develop asthma care plans, assign treatments and consistently monitor symptoms.

2. The second measure is Tobacco Use Screening and Cessation Intervention (TSC-E). The TSC-E measure assesses the percentage of persons 12 years of age and older who were screened for commercial tobacco product use at least once during the measurement period, and who received tobacco cessation intervention if identified as a tobacco user. The measure is based on recommendations from the United States Preventive Services Task Force (USPSTF) and aims to replace the survey-based Medical Assistance with Smoking and Tobacco Use Cessation (MSC) measure, which is being retired.
   
   TSC-E expands NCQA's focus on wellness and prevention, emphasizing the importance of screening and intervention for tobacco use. The measure encourages the use of evidence-based cessation interventions, such as behavioral counseling and pharmacotherapy, which have been shown to be effective in helping patients quit tobacco use, enabling healthcare organizations to provide personalized support for tobacco cessation. By prioritizing tobacco use screening and cessation intervention, healthcare providers can play a critical role in reducing the burden of tobacco-related illnesses, promoting healthier lifestyles and addressing disparities in healthcare.

The existing Adult Immunization Status (AIS-E) measure has been revised to include an additional assessment for COVID-19 immunization for adults 65 and over. The COVID-19 vaccine is a critical component of preventive care, particularly for adults 65 years and older, who are at highest risk of severe illness and death from COVID-19. The Centers for Disease Control and Prevention (CDC) reports that COVID-19 vaccination has prevented an estimated 18.5 million hospitalizations and 3.2 million deaths in the United States since the onset of the pandemic. As part of the Adult Immunization Status AIS-E measure, COVID-19 vaccination is assessed to ensure that eligible adults receive this critical vaccine, which has been shown to be cost-effective in preventing severe disease and hospitalization. Download our Measure Summary for more details on changes for MY2026.

Also from the CMS Call Letter, CMS indicates that NCQA is planning to implement a new ECDS-reported Transition of Care measure and a new ECDS-reported Care for Older Adults Measure in Measurement year 2027.

Hybrid Measure Retirement Timeline

NCQA has provided a timeline for retirement of the hybrid methodology on a measure-by-measure basis[1], with the ultimate goal of retiring the methodology by MY2029. For measurement year 2026, the hybrid methodology for Lead Screening in Children will be removed; this measure will be reported using the ECDS methodology beginning with MY2026.

The BPD-E measure allows for a two-year transition period until the BPD hybrid measure is replaced with the new BPD-E ECDS measure in Measurement year 2028. CMS indicates in the 2026 CMS Call Letter[2] that the transition to ECDS for the BPD measure will not represent a substantive change for STAR Rating purposes because the eligible population definition remains the same. The change is to the reporting method only.

New Specification Format

NCQA made several other changes to further align the traditional measures and measurement specifications with their digital measure counterparts. The format of Volume 2 specifications has changed so that now all measures are presented in the same tabular layout. This includes updated terminology such as:

Source System of Record (SSoR) is removed from the ECDS Data Elements tables.

NCQA's Digital Transformation

In the context of NCQA's digital transformation, these changes demonstrate a shift towards:

• Value-based care: By prioritizing coordination of care, patient engagement and prevention, these measures promote high-quality, cost-effective care.
• Data-driven insights: Digital data and analytics enable healthcare organizations to track patient outcomes, identify areas for improvement and optimize care pathways.
• Patient-centered care: These measures focus on patient needs, promoting timely follow-up care, personalized support and empowerment through education and counseling.
• Interoperability and connectivity: Digital technologies can facilitate seamless data exchange, care coordination and communication among healthcare providers, payers and patients.

By adopting these measures, healthcare organizations can leverage digital transformation to improve patient outcomes, enhance care coordination and promote preventive care, ultimately aligning with NCQA's vision for a more efficient, effective and patient-centered healthcare system.

The changes and updates for MY2026 mark an important step towards the digital transformation of HEDIS. As organizations prepare for these changes, they must prioritize building smarter, more connected measurement systems that align with national priorities and real-world care. By embracing these changes, organizations can not only meet compliance requirements, but also improve patient outcomes and quality of care.

Coming Up Next

The digital transformation of HEDIS is well underway, and hybrid methods will be gone before the decade ends. In our final blog in this Digital Quality series, we’ll cover challenges and opportunities, including a roadmap of practical steps to help you move forward confidently in the digital HEDIS era.

[1] https://wpcdn.ncqa.org/www-prod/wp-content/uploads/Digital-Transition-Webinar-12_2024.pdf

[2] https://www.cms.gov/files/document/2026-announcement.pdf