HEDIS® MY 2027: What’s New, What’s Changed, What’s Retired

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is continuously evolving to reflect clinical best practices and to support the needs of organizations that deliver and coordinate care.

For HEDIS Measurement Year (MY) 2027, NCQA introduced several updates:

• Added 6 new measures.
• Updated 3 existing measures.
• Transitioned 1 measure to Electronic Clinical Data Systems (ECDS) reporting.
• Restructured ECDS-reported measures reorganized by clinical domain.
• Made minor adjustments made across multiple measures.

Now Open: HEDIS Public Comment on Measure Retirement

NCQA seeks feedback about the proposed retirement of select HEDIS measures for Measurement Year (MY) 2027. The ad hoc public comment period is open from August 3 to August 17. Read on to learn more about the measures proposed for retirement and visit our public comment webpage to submit your comments.

New HEDIS Measures

The newest additions to HEDIS address follow-up after a positive colorectal cancer screening, prenatal syphilis screenings, person-centered outcome goals and the use of continuous glucose monitoring.

Two Screening Measures

Follow-Up After Positive Colorectal Cancer Non-Invasive Screening Test (COF-E). The percentage of persons 45–75 years of age who received a colonoscopy for a positive colorectal cancer non-invasive screening test.

Intent: Timely follow-up after a positive non-invasive colorectal cancer screening test helps complete the screening process and supports earlier detection and treatment. Delays in follow-up can reduce the value of screening and postpone treatment, increasing both cancer risk and mortality.

• The United States Preventive Services Task Force (USPSTF) recommends colorectal cancer screening for adults aged 45–75 years using stool-based or visual-structural tests.
• Follow-up requirement. A positive non-invasive screening test requires a colonoscopy to complete the screening process.
• Clinical importance. Successful cancer prevention and detection depends on timely follow-up after abnormal screening results.

Prenatal Syphilis Screening (PSY-E). The percentage of deliveries that had a syphilis screening during the first trimester or within 14 days of the first pregnancy diagnosis or prenatal visit or within 30 days of enrollment in the organization.

Intent: Prenatal syphilis screening helps identify and treat infection early in pregnancy, reducing the risk of congenital syphilis in newborns.

• The USPSTF recommends screening pregnant individuals for syphilis early in pregnancy or at the first prenatal visit.
• Clinical rationale. Untreated syphilis acquired before or during pregnancy can lead to congenital syphilis, with a transmission frequency of up to 90%. (1)
• Public health trend. Syphilis rates in pregnancy have risen sharply: In 2024, 3,941 infants were born with congenital syphilis—a nearly 700% increase from 2015, when 495 cases were reported. (2)

Three Person-Centered Outcome Measures

Person-Centered Outcome—Goal Identification (GID-E).

Person-Centered Outcome—Goal Follow-Up (GIF-E).

Person-Centered Outcome—Goal Achievement (GIA-E).

These measures assess the percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal, followed up on the goal and achieved it. They are found under the care coordination subdomain and are specified for reporting by members enrolled in Special Needs Plans (D-SNP and C-SNP). This is the first year that HEDIS Volume 2 will include the person-centered outcome (PCO) measures.

Intent: The PCO measures help individuals and/or caregivers work with clinicians to identify, track and achieve meaningful, measurable goals that support care planning, quality improvement and clinician accountability.

• Care alignment. Person-centered outcomes support whole-person care by aligning care delivery with individual goals and preferences.
• Clinical value. Goal-based care helps clinicians understand the outcomes individuals value, along with their preferences regarding conditions, possible treatments and tradeoffs. (3,4)
• For additional information, refer to NCQA’s person-centered outcome measures resource page.

One Utilization Measure

Continuous Glucose Monitoring Utilization for Patients With Diabetes (CGD-E). The percentage of persons 18–75 years of age with diabetes on insulin therapy who have evidence of continuous glucose monitoring (CGM) utilization during the measurement period.

Intent: CGM supports diabetes management by helping individuals and clinicians identify glucose trends, respond to hypoglycemic and hyperglycemic events and reduce the risk of serious diabetes-related complications. This utilization measure provides transparency into CGM utilization patterns and may help stakeholders identify potential gaps in CGM use.

• The American Diabetes Association recommends CGM use at diabetes onset and throughout treatment for adults using insulin therapy. (5)
• Utilization gap. Despite these recommendations, CGM use remains low among recommended populations and varies across subpopulations and payers.

Changes to Existing HEDIS Measures

Pharmacotherapy Management of COPD Exacerbation (PCE). Updated the measure to assess the percentage of persons 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.

Intent: The PCE measure was updated to align with the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) pharmacotherapy recommendations for patients who experience COPD exacerbations.

• Denominator changes. The measure transitioned from an episode-based denominator to person-based (meaning a member can only be reported in the measure once). The denominator now counts the number of persons who had a qualifying COPD exacerbation event during the measurement period.
• Exclusion changes. The measure now has an exclusion for persons with a comorbid diagnosis of asthma. Clinical guidelines state that individuals with comorbid asthma and COPD should prioritize asthma treatment recommendations over COPD treatment.
• Numerator changes. The measure now looks for dispensing events of appropriate COPD medications during the measurement period. This includes the timeframe prior to the COPD exacerbation event identified in the denominator.

Note: The PCE measure will be in first-year status for MY 2027 due to changes made during the re-evaluation.

Adult Immunization Status (AIS-E). Updated the pneumococcal indicator denominator age range to 50 and older and added two new age stratifications (50–64 and total), which will be reported in addition to the current 65 and older stratification.

Emergency Department Utilization (EDU). Added the Medicaid product line for members 18–64 years of age.

Cross-Cutting Topics

Death Exclusion. Expanded the death exclusion criteria to include persons who died any time on or before the last day of the measurement period.

Changes to the Order of Measures. Removed the Measures Reported Using Electronic Clinical Data Systems domain. Measures from this domain are now located in clinically specific domains (for example, Breast Cancer Screening (BCS-E) is now found under the Prevention and Screening subdomain).  

Race and Ethnicity Stratification Reporting. Updated the race and ethnicity stratification categories and data element tables to capture declinations and unknown race and/or ethnicity more precisely.

Palliative Care Exclusion. Modified the value sets and codes used to identify this exclusion.

ECDS Reporting

NCQA will allow voluntary ECDS reporting for the Glycemic Status Assessment for Patients With Diabetes (GSD-E) measure. Click here for information about the transition to ECDS reporting.

Measures Under Consideration for Retirement in MY 2027 

NCQA is evolving HEDIS to better reflect where quality measurement is headed: toward a more focused, meaningful measure set that delivers clearer, more actionable signals and supports improvement in care, accountability and value across the healthcare system. Measure retirement is an important part of this ongoing curation work, helping ensure that HEDIS adapts to advances in evidence, clinical practice, data availability, policy priorities and stakeholder needs.

NCQA is evaluating the following measures for potential retirement as part of its ongoing measure curation process:

• 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).
• Documented Assessment After Mammogram (DBM-E).
• 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).

In HEDIS Volume 2, these measures are listed as “Pending Retirement” in the “What’s New in Volume 2” section and also alongside each measure name in the individual measure specification. The decision to retire these measures is not final and is pending an August 3–17 public comment period, followed by a Committee on Performance Measurement review in September. If approved, these measures will be removed from HEDIS MY 2027 Volume 2 during the March 2027 Technical Update.

New Specification Enhancements Coming for MY 2028

With the release of MY 2027 Volume 2, NCQA has released a memo introducing specification enhancements planned for MY 2028. Two example HEDIS measure specifications, Prenatal Syphilis Screening (PSY-E) and Colorectal Cancer Screening (COL-E), are included to show the planned enhancements. The enhancements clarify data source expectations and promote consistent translation of narrative specifications into computable logic, while preserving current reporting and audit practices. These improvements are a continuation of the HEDIS digital measurement transition that started with the release of the ECDS reporting method.

Learn More

Get the HEDIS MY 2027 Volume 2: Technical Specifications in the NCQA Store. The publication purchase will include the new specification enhancements memo and example measures.

Visit the Digital Quality Hub to learn about the transition to digital quality measurement.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

References

1. Pérez-Cavazos, Samantha, María Mayela Rodríguez-Saldívar, Abiel Homero Mascareñas-De los Santos, and José Iván Castillo-Bejarano. “Congenital Syphilis: The Irrevocable Burden of a Late Diagnosis.” Pediatrics & Neonatology 63 (3): 306–7. https://doi.org/10.1016/j.pedneo.2021.10.006.
2. Centers for Disease Control and Prevention. (2025). Sexually transmitted infections surveillance, 2024 (provisional).
3. Lenzen, S. A., Daniëls, R., van Bokhoven, M. A., van der Weijden, T., & Beurskens, A. (2017). Disentangling self-management goal setting and action planning: A scoping review. PLoS ONE, 12(11). https://doi.org/10.1371/journal.pone.0188822
4. Vermunt, N. P. C. A., Harmsen, M., Westert, G. P., Olde Rikkert, M. G. M., & Faber, M. J. (2017). Collaborative goal setting with elderly patients with chronic disease or multimorbidity: A systematic review. BMC Geriatrics, 17(1), 167. https://doi.org/10.1186/s12877-017-0534-0
5. American Diabetes Association. (2026). Continuous Glucose Monitors. https://diabetes.org/advocacy/cgm-continuous-glucose-monitors