The shift to fully digital HEDIS® reporting is no longer a distant goal. NCQA is collaborating with health care organizations across the industry to make HEDIS reporting fully digital by Measurement Year (MY) 2030. The evolution of HEDIS—and digital quality measurement, in general—leverages available electronic health data to make quality measurement more accurate, actionable, timely, and affordable.”

NCQA is actively phasing out the hybrid method by MY 2029, and all measures will either use Administrative only or Electronic Clinical Data Systems (ECDS) by this time (NCQA Guidance). This transition is already underway, starting with a core set of measures that are ECDS only for MY 2025. By MY 2030, all HEDIS measures will be digital, retiring the familiar hybrid methodology that many payers rely heavily on.

This evolution is intended to make quality measurement more accurate, timely, and cost-effective, but it comes with significant demands on health plans. Full-population measurement will be required, meaning plans must use validated electronic clinical data from across the care continuum. The old playbook of sampling member records and manually abstracting charts is being replaced by digital sources like:

• Electronic Health Records (EHRs)
• Health Information Exchanges (HIEs)
• Clinical registries
• Case management systems
• Administrative claims systems

And the stakes are high. Accurate and complete data will directly influence plan ratings, especially for Medicare Advantage plans, where it is estimated that bonus and rebate eligible plans (based on star ratings) can translate into $2,000 or more per member per year in combined rebates and quality bonus payments.

The Data Challenge Payers Face

Many health plans still rely heavily on administrative claims and sample-based EHR data acquired through a variety of legacy connections and chart requests. But with NCQA’s digital transformation, payers must now be able to ingest data from multiple clinical systems, securely, at scale, and promptly.

That means answering tough questions:

• Where do we already have usable electronic clinical data?
• Which provider connections are underperforming or no longer fit for purpose?
• What percentage of our population is “covered” with valid digital data?
• Who are the HIEs, registries, QHINs, or other technology vendors that can help fill our gaps?
• How do we ensure that we have high-quality, usable data for our HEDIS processes?
• How can we align our data strategy with high-impact contracts and member populations?

POCP has been working with national and regional plans to assess these exact questions and map out phased, multi-year roadmaps for HEDIS data transformation.

What Payers Need to Do Now

Audit your current data landscape
Understand your existing data sources and evaluate timeliness, completeness, and usability for digital quality measurement.

Build a prioritized connection strategy
Don’t try to boil the ocean. Focus first on member populations tied to your highest-impact plans and contracts. Evaluate which data partners—HIEs, EHR vendors, QHINs—can help you make the biggest leap forward.

Prepare for validation
Data used for HEDIS reporting must be validated through the audit process. Documented processes for making this data available to care teams and for tracking provider data requests are required.

Engage clinical and technical teams early
Digital quality is not just a data team problem. Success requires alignment across clinical operations, IT, compliance, and quality teams.

Does Your Organization Need Support?

POCP brings deep expertise at the intersection of health IT, quality reporting, and standards-based data exchange. We’re helping payers:

• Design realistic roadmaps that meet both NCQA timelines and budget constraints
• Identify and prioritize the right vendor and data exchange partners
• Navigate standards like HL7® FHIR®, CCDA, CDex, and DEQM
• Align their quality data strategies with broader interoperability efforts (e.g., Provider Access API, TEFCA)

We’re not just system integrators or compliance chasers, we’re objective partners who understand both the technical and strategic sides of this quality transformation.

Let’s talk about your digital quality readiness and how POCP can help you objectively assess your current capabilities and resources to build a strategy that works. Reach out to set up a time to tell us about your organization’s goals and challenges.