NCQA’s 2026 Trends to Watch
January 15, 2026 · Becky Kolinski
It’s a new year, and the NCQA team is ready to take on some of healthcare’s biggest challenges. We’ve compiled a list of our key focus areas for 2026. Read on to learn what’s next in healthcare quality.
Re-Thinking Our Approach to Population Health
NCQA’s Wellness and Health Promotion Accreditation and Certification program has been in place for more than a decade, helping organizations design programs that engage people in improving their health. In 2025, NCQA started the Innovations in Wellness and Condition Management Working Group to update the program to reflect best practices and new technologies for evaluating population risk and providing self-management and coaching to help improve health outcomes. This is part of a larger effort to evaluate how high-quality population health services are delivered across NCQA programs.
“As an industry, we have an opportunity to redefine our approach to population health and how we prevent and manage chronic disease,” says Rachel Harrington, PhD, NCQA’s Senior Product Strategist. “We know that 40-60% of the factors that influence a person’s health come from outside the walls of the healthcare system. With limited resources, especially in primary care and behavioral health, it is important to help support people in managing their health, including the use of digital technologies.”
In 2026, NCQA will start shaping these new standards, focusing on evaluating outcomes and supporting confident decision-making on digital health and wellness solutions. This isn’t just a focus for NCQA. “It’s validating to see that our work aligns with the CMS Innovation Center’s new ACCESS model,” says Harrington. “We hope it will motivate organizations to innovate and improve the patient experience.”
Understanding Health Differences Within Populations and Communities
Improving population and community health requires organizations to identify variations in health outcomes, look for the root causes and target solutions to populations and communities. The upstream, structural and personal factors that drive differences in health outcomes are complex and multifaceted—and often require data, investments and partnerships broader than the healthcare system. NCQA’s Accreditations in Health Outcomes and Community-Focused Care give organizations a framework to understand differences and close gaps.
“We’ve updated our program to give organizations more ways to view population and community health and a greater ability to tailor the program to the areas most relevant to the populations they serve,” says Elizabeth Ryder, NCQA’s Assistant Director, Product Management. “For example, disability status is a new population focus for Health Outcomes Accreditation, which complements a new HEDIS® measure that we introduced in measurement year 2026.”
Listen to our podcast, One in Four: Making Disability a Quality Priority, to learn more about these changes.
Shaping the Future of Primary Care
Primary care is evolving at an astounding pace. NCQA’s Patient-Centered Medical Home Recognition program laid the foundation by providing an operational and quality improvement framework for primary care. Now, we are helping practices advance their relationships with payers and succeed in value-based care.
“We are looking at the next horizon for primary care,” says Jeff Sitko, NCQA’s Assistant Vice President, Product Management. “We have an opportunity to create a best practice, scalable delivery model that provides a blueprint for primary care practices to continue developing their capabilities. We want to work side-by-side with practices to understand what’s valuable and realistic, while also reducing administrative burden.”
Stay tuned for an announcement about our primary care partners. In the meantime, listen to our Quality Matters podcast, What’s New and What’s Next for Primary Care.
Integrating Primary Care and Behavioral Healthcare
People with mental health conditions and substance use disorders are more likely to experience chronic health conditions like heart disease and diabetes. Similarly, people who are living with chronic conditions may struggle with depression or anxiety. Integrated care models that combine behavioral health and primary care can improve access and coordination, leading to better health outcomes.
“We need more care delivery models that support whole-person care,” says Julie Seibert, PhD, NCQA’s Assistant Vice President, Behavioral Health. “Integrating behavioral health and primary care can improve access and coordination of care by meeting people where they are and implementing a ‘no wrong door’ policy when it comes to accessing behavioral health services.”
In 2026, NCQA will continue to promote integration, with funding from the Health Resources and Services Administration, to support Federally Qualified Health Centers and Look-Alike Health Centers seeking NCQA’s Distinction in Behavioral Health Integration.
We’ve also updated our Behavioral Health Accreditation program to strengthen the focus on population health and network adequacy. Read our blog post, Behavioral Health Accreditation Promotes Accountability, to learn more.
Advancing the Transition to Digital Quality Measurement
The transition to digital quality measurement is accelerating as healthcare moves rapidly toward interoperability and real-time data exchange. Most HEDIS measures are available in a digital format, ready for implementation. From building CQL engines to integrating digital measures at the point of care, organizations are making progress and showing tangible results.
“The year 2030 is our north star to become fully digital, and industry alignment is critical for success,” says Tricia Elliott, NCQA’s Vice President, Quality Implementation. “There are 3 parallel tracks that need to converge for us to continue forward progress: updates to the CMS Digital Quality Measures Roadmap, conversion of data to the HL7® FHIR® standard and clarity on the use of USCDI Core versus USCDI QI Core standards. The more we can build alignment, the easier it will be for everyone to do the work we need to do by 2030.”
In 2026, we anticipate broader adoption of digital HEDIS measures, supported by certification and parallel testing. NCQA recently launched a Digital Quality Measure Evaluation Package that includes a sample of digital HEDIS measures and supporting tools to help explore, test and plan your transition with confidence. Our Digital HEDIS Directory highlights how organizations are using NCQA’s digital HEDIS measures to modernize care delivery, drive efficiencies and improve outcomes.
Visit NCQA’s Digital Quality Hub for more resources to support your transition.
Expanding Use of Clinical Data in HEDIS®
HEDIS is evolving to provide a more complete picture of care for populations, enabled by increased integration of clinical data. In Measure Year 2026, we will implement 6 new Electronic Clinical Data Systems (ECDS) measures and 3 measures will transition to ECDS-only.
“While every organization is on its own journey in incorporating clinical data, what remains constant is the trust in a reported HEDIS rate,” says Taylor Musser, NCQA’s Director, Measure and Data Operations. “This is driven in part by the audit requirements holding all organizations to the same expectations for data contributing to HEDIS. While a measure may be new or updated, the HEDIS Compliance Audit™ helps to ensure an apples-to-apples comparison as HEDIS evolves.”
Read our blog post, HEDIS MY 2026: What’s New, What’s Changed, What’s Retired, to learn more about what you can expect in 2026.
Improving Quality of Care for Patients with Cardiovascular-Kidney-Metabolic Syndrome
NCQA conducted 3 expert convenings in 2025 to gather insights and help define our quality measurement approach related to Chronic Kidney Disease and Cardiovascular-Kidney-Metabolic (CKM) Syndrome. We are excited to accelerate this work in 2026.
“We’re interested in exploring quality measures that focus on risk assessment and prevention because if you can prevent one of these CKM-related diseases, you can often prevent them all,” says Caroline Blaum, MD, NCQA’s Assistant Vice President, Chronic Conditions and Complex Care. “I anticipate that 2026 will be a year of significant progress as we define our measurement approach and begin testing with real-world data.”
NCQA recently released a white paper that synthesizes what we learned from the convenings and makes recommendations for a holistic approach to the prevention and management of CKM syndrome.
Defining High Quality Diabetes Care
Diabetes is one of the diseases intertwined within the CKM framework. NCQA’s Diabetes Recognition Program recognizes clinicians who use evidence-based measures to provide high-quality care to patients with diabetes. We added 3 new measures to the program for 2026: Statin Therapy Prescription, Depression Screening and Follow-Up and Continuous Glucose Monitoring (CGM) Utilization. The CGM Utilization measure is the first step toward understanding and quantifying the growing use of this technology.
“The new CGM Utilization measure will help us understand where the technology is being used, which populations are using it and whether there are barriers limiting adoption,” says Emily Hubbard, MPH, NCQA’s Senior Research Associate. “Our goal is to standardize the data to help organizations capture and report on utilization within a defined population of patients with diabetes. This effort will lay the groundwork for NCQA to develop a broader CGM performance measurement approach in the future.”
Learn more about recent updates to the Diabetes Recognition Program, or access the standards in the NCQA store.
Reducing the Administrative Burden of Utilization Management
NCQA continually evaluates its standards and programs to ensure they remain relevant and useful for the industry. This includes reducing administrative burden so organizations can focus on what matters most: providing high-quality, accessible care. Interoperability is the key to transforming cumbersome processes, like prior authorizations.
“In 2026, we will start to see the impact of the CMS Interoperability and Prior Authorization Final Rule, which should make the process less burdensome and more efficient,” says Tsveta Polhemus, NCQA’s Assistant Vice President, Product Management. “NCQA’s revised utilization management standards are tightly aligned with the federal rules, and extend beyond them, as we also include commercial plans. We provide guidance to help plans analyze denial and appeal rates to identify what’s working and what’s not so they can provide a better experience for clinicians and patients.”
Read our blog post, Breaking Down Silos in Utilization Management: A Data-Driven Approach, to learn more about the updates to NCQA’s utilization management standards.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
HEDIS® Compliance Audit™ is a trademark of the National Committee for Quality Assurance (NCQA).
HL7® and FHIR® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.
