Preparing for HEDIS MY 2028: What New Risk-Adjusted Utilization Strategies Mean for Your Organization
- Tuesday, July 21, 2026
- 1:00 PM (ET)
As health care delivery evolves, so must the measures used to evaluate it. HEDIS® risk-adjusted utilization measures are being re-examined to better reflect today’s clinical realities, utilization patterns and the needs of diverse populations.
In this forward-looking session, NCQA experts will share key updates under consideration for measurement year 2028—focused on modernizing methodology, improving accuracy and advancing person-centered measurement.
Attendees will gain insight into four three priority areas shaping the future of risk-adjusted utilization:
- Enhancing identification of high-frequency utilizers to better capture vulnerable populations.
- Aligning comorbidity categories with the latest CMS-HCC model.
- Incorporating denied claims to more fully represent utilization.
What You’ll Learn
- Key proposed updates to risk-adjusted utilization measures for HEDIS MY 2028
- How evolving methodologies may impact performance and reporting
- The reasoning behind new approaches to outliers, denied claims and risk adjustment inputs
Why Attend
Stay ahead of upcoming HEDIS changes and gain practical insight to help your organization prepare, adapt and succeed in a shifting measurement landscape.
Danielle Rainis
Danielle Rainis
Danielle Rainis, MPH, is a Senior Research Associate in NCQA’s Quality Measurement and Research Group. She leads the development and maintenance of HEDIS measures focused on respiratory health, antibiotic use and risk-adjusted hospital and emergency department utilization. Ms. Rainis has over 7 years of experience analyzing nationally representative administrative claims databases and translating findings into feasible and clinically meaningful quality measures. She spearheaded the development of several risk-adjusted measures of acute hospitalizations following outpatient surgeries, a novel area for HEDIS at the time. Her current work centers on advancing innovative, actionable performance measures that improve care quality across health plans and delivery systems.
Lauren Campbell
Lauren Campbell
Lauren Campbell, MA, PhD, is an Applied Research Scientist at NCQA in Sciences and Implementation where she oversees the Risk-Adjusted Utilization, Long-Term Services and Supports, and Older Adults measure portfolios. She has over 10 years of experience in managing quantitative workstreams, designing and implementing plans for multivariate analyses and leading quantitative teams on large-scale national implementation and evaluation projects. Her work centers on quality measurement for populations with higher risk, including individuals with advanced illness and multiple chronic conditions. Dr. Campbell has expertise in data management and analysis of primary and secondary data sources, including national claims, administrative and assessment data, in both internal and external environments. She leads the delivery of analytic results, including development of technical reports, manuscripts and research briefs, and presents findings to federal clients, stakeholders and clinician panels. Prior to joining NCQA, Dr. Campbell led quantitative workstreams and implemented claims-based spending, utilization and quality measures in Center for Medicare & Medicaid Innovation (CMMI) Model evaluations. In this role, she conducted special studies using mixed methods to evaluate outcomes for individuals using post-acute care and long-term services and supports. Dr. Campbell also co-led and managed quantitative tasks for clinical review, reclassification and recalibration of CMS-Hierarchical Condition Category (HCC) risk adjustment models used in Medicare Advantage, including End Stage Renal Disease (ESRD) and frailty models, and led the quality measure testing and validation tasks for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) and Nursing Home Quality Initiative (NHQI).
Ezra Fishman
Ezra Fishman
Ezra Fishman, PhD, is a Lead Data Scientist in NCQA’s Quality Measurement and Research Group. He oversees data analysis for development and maintenance of HEDIS measures. He also conducts statistical analysis for development and testing of NCQA’s risk-adjusted utilization measures such as Plan All-Cause Readmissions (PCR). He has a decade of experience analyzing large health insurance claims datasets, and a strong track record of turning health care data into actionable findings for health care payers and providers, while contributing to the scientific literature on health care delivery.
Subscribe
Get notified about upcoming NCQA events.