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The National Committee for Quality Assurance (NCQA) is poised to reshape healthcare quality measurement with the HEDIS® Measurement Year (MY) 2026 Technical Specifications, introducing seven new measures and considerable updates to existing ones. These changes, impacting risk-adjusted outcomes, electronic clinical data system (ECDS) reporting, and member demographic data, demand immediate attention from health plan leaders to ensure compliance and optimize performance. According to a company release, a detailed comparison of the MY 2026 specifications against previously proposed materials revealed key adjustments informed by public feedback.
A Wave of New Measures for 2026
NCQA will introduce four new risk-adjusted measures and two new ECDS measures, alongside a new health plan descriptive information measure, all slated for reporting in 2026. The risk-adjusted measures, initially proposed in February 2024, aim to provide a more nuanced understanding of patient outcomes.
HFC: Acute Hospitalizations Following Outpatient Colonoscopy measures the ratio of observed-to-expected unplanned acute hospitalizations after an outpatient colonoscopy. NCQA clarified that hospitalizations occurring on the day following the procedure will not be included in the denominator, while those within 2-15 days will be counted in the numerator. A senior official stated that the exclusionary criteria were refined by removing exclusions related to pregnancy or perinatal conditions and differentiating between GI endoscopy and secondary colonoscopy exclusions.
Similar risk-adjusted measures – HFG (General surgery), HFO (Orthopedic Surgery), and HFU (Urologic Surgery) – follow the same methodology, assessing unplanned acute hospitalizations following these respective outpatient procedures. All three share consistent denominator and numerator exclusion criteria, with the removal of pregnancy and perinatal condition exclusions.
ECDS Measures Evolve
Two new ECDS measures are set to debut in 2026,signaling a continued shift towards leveraging electronic data for quality reporting.
AAF-E: Follow-Up After Acute and Urgent Care Visits for Asthma replaces the retired Asthma Medication Ratio (AMR) measure.This new measure assesses appropriate follow-up care after acute events, with expanded eligibility criteria allowing asthma diagnoses to appear in any claim position. Denominator events stemming from ED or urgent care visits can now be excluded if followed by an inpatient stay within 30 days, with previous exclusions for acute respiratory failure and emphysema removed. NCQA also stipulated that a diagnosis of asthma is now required for follow-up visits to qualify as numerator-compliant.
TSC-E: Tobacco Use Screening and Cessation Intervention replaces the CAHPS® survey measure, evaluating the percentage of individuals screened for tobacco use and those receiving cessation intervention. Notable updates include the addition of palliative care as an exclusion and the removal of specific ICD-10 codes for tobacco use identification. NCQA confirmed upcoming data element changes, including the removal of Benefit metadata and the addition of a reporting table for Medicare.
New Insights into Membership: The DDM Measure
the new descriptive measure, DDM: Disability Description of Membership, evaluates the number of health plan members who identify as disabled. Compared to the public comment version, the finalized measure eliminates age restrictions and secondary disability stratification, focusing solely on identifying disabled versus non-disabled members across the entire population.NCQA emphasized that plans should prioritize a member’s reported disabled status to avoid undercounting and classify “declined” or “prefer not to answer” responses as missing data.
Broad Updates to Existing HEDIS Specifications
Beyond the new measures, NCQA is implementing widespread updates to existing HEDIS specifications and reporting elements. One major change involves adding, renam
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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.
