The National Committee for Quality Assurance (NCQA) has announced several upcoming changes to the Healthcare Effectiveness Data and Information Set (HEDIS®) that will influence how organizations measure, report, and improve quality of care.1 For Measurement Year (MY) 2027, these updates reflect emerging clinical priorities, advances in technology, and the healthcare industry’s continued shift toward digital quality measurement.2
Key changes include the introduction of six new measures, updates to existing measures, expanded use of Electronic Clinical Data Systems (ECDS) reporting, and the potential retirement of several longstanding measures. Collectively, these updates highlight the future direction of healthcare quality measurement and underscore the need for organizations to begin preparing now. While intended to improve accuracy, align with current clinical guidelines, and address evolving health priorities, the changes will also require organizations to reassess their compliance processes, data management capabilities, and performance improvement strategies.
Here’s a quick look at the key MY 2027 changes organizations should begin tracking now.
| What’s changing | Measures to watch | Why it matters for HEDIS readiness |
|---|---|---|
| New prevention-focused measures |
| These measures reinforce the importance of closing care gaps earlier, improving follow-up after abnormal screenings, and strengthening prenatal care workflows. |
| New person-centered outcome measures |
| These measures signal a broader shift toward outcomes that reflect individual goals, preferences, and meaningful progress for members with complex care needs. |
| New technology adoption measure |
| This measure gives organizations greater visibility into CGM use among insulin-treated adults with diabetes and may help identify barriers to technology access. |
| Updated clinical and utilization measures |
| These updates may require organizations to revisit measure logic, denominator strategies, exclusion criteria, and population monitoring approaches. |
| Expanded digital reporting |
| Voluntary ECDS reporting for GSD-E continues the shift toward more digitally enabled quality measurement and reinforces the need for reliable clinical data capture. |
| Potential measure retirements |
| Organizations should monitor final retirement decisions, but any measures finalized for retirement are not expected to be removed until the March 2027 Technical Update. |
What new HEDIS measures are being introduced for MY 2027?
Six new measures are being introduced for MY 2027, organized across three primary categories outlined below:
A growing focus on prevention and early intervention
Two new HEDIS measures emphasize the importance of closing care gaps earlier and improving outcomes through timely interventions:
Follow-up after positive colorectal cancer screening: The Follow-Up After Positive Colorectal Cancer Non-Invasive Screening Test (COF-E) measure evaluates the percentage of individuals ages 45 to 75 who receive a colonoscopy for a positive colorectal cancer non-invasive screening test. The rationale is straightforward: screening is only effective when abnormal results are appropriately followed up. Delays in obtaining a colonoscopy can reduce the value of initial screening efforts and postpone treatment, increasing cancer risk and mortality. The new measure reinforces the importance of care coordination and timely outreach to patients following abnormal test results.3,4
Prenatal syphilis screening: The Prenatal Syphilis Screening (PSY-E) measure assesses the percentage of deliveries that had a syphilis screening during the first trimester, shortly after pregnancy diagnosis or prenatal visit (within the first 14 days) or within 30 days of enrollment in the organization.
The measure reflects growing concern over rising congenital syphilis rates nationwide, with cases increasing by 700% since 2015, according to a 2024 report.5 Early identification and treatment can help reduce serious complications for both mothers and newborns. For health plans and providers, this measure highlights the need for strong prenatal care workflows and comprehensive clinical data capture.
Person-centered care measures
Perhaps the most transformative addition to HEDIS MY 2027 is the introduction of three new Person-Centered Outcome (PCO) measures:
- Goal Identification (GID-E)
- Goal Follow-Up (GIF-E)
- Goal Achievement (GIA-E)
These measures assess the percentage of individuals 18 years of age or older with complex care needs who have established meaningful personal health goals, follow up on them, and ultimately achieve them. They are designed for Special Needs Plans, including D-SNPs and C-SNPs, and represent a significant shift toward measuring outcomes that matter directly to patients.
Rather than focusing solely on clinical processes, these measures evaluate how effectively care teams align treatment plans with individual preferences and priorities. They also support the broader movement toward whole-person care and offer a framework for understanding the outcomes individuals value, along with their preferences regarding conditions, possible treatments, and tradeoffs.
For organizations, this means quality improvement programs may need to incorporate new workflows, documentation practices, and care management strategies that support goal-based care.
Measuring adoption of continuous glucose monitoring
Another important addition is the Continuous Glucose Monitoring Utilization for Patients with Diabetes (CGD-E) measure. This new utilization measure evaluates the percentage of insulin-treated adults ages 18–75 with diabetes and evidence of continuous glucose monitoring (CGM) during the measurement period.
CGM is increasingly viewed as a best practice for diabetes management because it can help patients and clinicians monitor glucose trends with greater precision, reduce complications, and improve disease control.6 Despite clinical recommendations, utilization remains inconsistent across populations and payer types.
This measure gives plans and providers visibility into adoption rates and may help identify barriers that prevent patients from accessing these technologies.
What HEDIS MY 2027 changes affect existing measures?
NCQA also updated several existing measures, including the key changes highlighted below.
Pharmacotherapy management of COPD exacerbation
The Pharmacotherapy Management of COPD Exacerbation (PCE) measure was revised to align with updated clinical guidelines for individuals 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. Changes include:
- Moving from an episode-based denominator to a person-based denominator.
- Adding exclusions for members with comorbid asthma.
- Looking for dispensing events of appropriate COPD treatments during the measurement period.
The update ensures that all patients with qualifying COPD exacerbations are included, regardless of episode frequency, better aligns with updated clinical guidelines, encourages consistent medication use across episodes, and improves data accuracy and reporting.7 The PCE measure will have first-year status for MY 2027.
Adult immunization status
The age range for the pneumococcal immunization indicator within the Adult Immunization Status (AIS-E) measure has been updated. The denominator now includes individuals aged 50 and older, with two new reporting stratifications for ages 50-64 and total.
This update better aligns measurement with evolving vaccination recommendations and public health priorities.
Emergency department utilization
The Emergency Department Utilization (EDU) measure now includes Medicaid members ages 18-64, expanding visibility into emergency department usage patterns within this population.
What additional updates are included in HEDIS MY 2027?
MY 2027 reflects the continued move from traditional quality reporting to digital measurement, with one measure transitioning to ECDS reporting and ECDS-reported measures reorganized by clinical domain:
- NCQA removed the standalone ECDS reporting domain and reorganized ECDS-reported measures within their respective clinical domains. For example, Breast Cancer Screening (BCS-E) now appears within the Prevention and Screening domain instead of a separate ECDS category.
- Additionally, NCQA will allow voluntary ECDS reporting for the Glycemic Status Assessment for Patients with Diabetes (GSD-E) measure.
Other adjustments to measures include:
- The expansion of the death exclusion criteria to include persons who died any time on or before the last day of the measurement period.
- Updated race and ethnicity stratification categories and data element tables to capture declinations and unknown race and/or ethnicity more precisely.
- Modification of the palliative care exclusion value sets and codes used to identify this exclusion.
Which HEDIS measures may be retired for MY 2027?
For MY 2027, NCQA is proposing to retire ten HEDIS measures through its structured measure curation process. Organizations should continue to follow current HEDIS specifications and reporting requirements until NCQA communicates a final decision.
Measures under consideration include:
- 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).
- 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).
- Documented Assessment After Mammogram (DBM-E).
While retirement decisions have not yet been finalized, these proposals reflect NCQA’s focus on maintaining a more meaningful, actionable, and streamlined measure set. It is also important to note that any measures finalized for retirement are not expected to be removed until the March 2027 Technical Update.
How can MedInsight help your organization prepare for HEDIS?
As HEDIS evolves, accurate, trusted, and integrated data becomes increasingly critical for quality performance. Organizations must track changing specifications, identify care gaps, monitor measure performance, and prepare for growing digital reporting requirements. Milliman MedInsight (MedInsight) closely monitors changes like these to help ensure our analytics remain current, accurate, and ready to support users as they prepare for HEDIS reporting and submission.
In addition, MedInsight helps healthcare organizations take control of HEDIS performance through a suite of purpose-built solutions designed to close care gaps, improve data integrity, and drive quality outcomes. At the foundation is the MedInsight Payer Platform and Value-based Care (VBC) Platform, a cloud-native analytics environment that integrates claims, eligibility, clinical, and financial data into a single trusted source of truth, underpinned by a rigorous Data Confidence Model with more than 100 automated audits and 60+ stringent data tests.
MedInsight’s Clinical Data Integration capabilities further enhance this foundation by aggregating and normalizing clinical data from disparate EHRs and other clinical sources to create a comprehensive longitudinal patient record. By unifying clinical and claims data across providers and care settings, organizations gain a more complete and near-real-time view of member health, enabling more accurate quality measurement, earlier identification of care opportunities, and improved capture of clinical evidence needed to close HEDIS gaps.
Building on this foundation, MedInsight Evidence-Based Measures (EBMs)—certified by NCQA for HEDIS® Measurement Year (MY) 2026—enable organizations to accurately identify eligible member populations for each quality measure, assess compliance against established clinical guidelines, and track care gaps at the member, provider, and population level. Together, MedInsight’s analytics, clinical data integration, and certified quality measure capabilities empower healthcare organizations to shift from retrospective reporting to proactive quality improvement, using actionable data-driven insights to identify opportunities, close gaps, and strengthen performance.
Complementing the EBMs, the MedInsight Risk Adjustment Platform strengthens HEDIS performance by integrating and validating data from multiple sources, identifying documentation gaps, and ensuring diagnoses are accurately captured, so organizations caring for complex populations receive fair, accurate quality comparisons and appropriate reimbursement.
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References
- HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). ↩
- HEDIS® MY 2027: What’s New, What’s Changed, What’s Retired – NCQA ↩
- NCQA Advances Development of a New HEDIS® Measure for Colorectal Cancer Screening Follow-Up – NCQA ↩
- Improving follow-up of abnormal stool test results used for colorectal cancer screening – Gastrointestinal Endoscopy ↩
- Congenital syphilis cases rise for 12th consecutive year | AAP News | American Academy of Pediatrics ↩
- Using Continuous Glucose Monitoring in Clinical Practice | Clinical Diabetes | American Diabetes Association ↩
- Changes to Existing HEDIS® Measure: Pharmacotherapy Management of COPD Exacerbation (PCE) ↩
