Data, Measurement and Equity
To improve equity, first measure it.
Although every organization has a responsibility to examine and improve how its policies, practices and technology perpetuate or exacerbate health inequities, mitigating the adverse effects of health inequities requires collaboration across the health care industry, as well as beyond it, into communities that health care organizations serve and at the state and federal levels. NCQA believes that its role in advancing health equity is twofold:
- Design programs, products and measures that guide and support health care organizations in creating structures, processes and partnerships that illuminate health inequities, and in investigating their role in undoing biases and eliminating inequities.
- Leverage HEDIS to hold health care organizations accountable for highlighting and acting to reduce existing disparities.
Stratifying HEDIS Measures By Race & Ethnicity
Race and ethnicity data may be used to inform efforts to identify and eliminate health disparities, not to suggest race is a biological determinant of health. NCQA acknowledges that race is a social construct and a proxy for social, environmental and political forces that influence health, including structural and institutional discrimination and racism. Race does not cause health inequities; rather, the conditions and systems in which patients are born, grow, work, live and age directly impact gaps in care and outcomes. These systemic forces may manifest as inequities in care and health outcomes. In order to correct these racial and ethnic inequities where they exist, they need to be identified, named and confronted. Health plans should use race and ethnicity stratifications of HEDIS data to confront and correct disparities in care, not to further bias health care.
Stratifying HEDIS measures is part of NCQA’s commitment to include health equity in all offerings. As of measurement year 2026, a total of 22 HEDIS measures can be stratified by race and ethnicity.
How does stratification work within HEDIS measures?
- Align race and ethnicity reporting with Office of Management and Budget categories. As of MY 2026, NCQA requires reporting on the Middle Eastern or North African (MENA) category in alignment with the OMB guidelines updated in 2024.
- Include options for “declined” if a member chooses not to provide race or ethnicity.
- Stratify separately by race and ethnicity.
To learn more about HEDIS stratification, visit The Future of HEDIS.
Download the Resource Guide for Auditors.
What measures can be stratified by race and ethnicity?
For more information on measures in which stratified rates will be publicly reported as aggregate benchmarks (not plan-level results) for MY 2024, visit the HEDIS MY 2024 Public Reporting Memo.
BY DOMAIN
Currently required in NCQA’s Health Equity Accreditation.
* Stratified rates will be publicly reported as aggregate performance distributions for MY 2025.
Access and Availability of Care
| Measure | Stratification Added | ECDS Only |
| * Prenatal and Postpartum Care (PPC) |
MY 2022 | n/a |
| * Initiation and Engagement of Substance Use Disorder Treatment (IET) | MY 2023 |
Behavioral Health
| Measure | Stratification Added | ECDS Only |
| * Follow-Up After Emergency Department Visit for Substance Use (FUA) | MY 2023 | n/a |
| * Pharmacotherapy for Opioid Use Disorder (POD) | MY 2023 | |
| Follow-Up After Hospitalization for Mental Illness (FUH) | MY 2024 | |
| Follow-Up After Emergency Department Visit for Mental Illness (FUM) | MY 2024 |
Cardiovascular
| Measure | Stratification Added | ECDS Only |
| * Controlling High Blood Pressure (CBP) |
MY 2022 | n/a |
Diabetes
| Measure | Stratification Added | ECDS Only |
| * Glycemic Status Assessment for Patients With Diabetes (GSD) |
MY 2022 | n/a |
| Eye Exam for Patients With Diabetes (EED) | MY 2024 | n/a |
| Kidney Health Evaluation for Patients With Diabetes (KED) | MY 2024 | n/a |
Measures Reported Using ECDS
| Measure | Stratification Added | ECDS Only |
| * Adult Immunization Status (AIS-E) | MY 2023 | MY 2018 |
| Blood Pressure Control for Patients With Hypertension (BPC-E) | MY 2025 | MY 2025 |
| * Breast Cancer Screening (BCS-E) | MY 2023 | MY 2023 |
| * Colorectal Cancer Screening (COL-E) |
MY 2022 | MY 2024 |
| Childhood Immunization Status (CIS-E) Note: Stratification is only specified for Combo 10—all vaccines. |
MY 2024 | MY 2025 |
| Cervical Cancer Screening (CCS-E) | MY 2024 | MY 2025 |
| * Immunization for Adolescents (IMA-E) | MY 2023 | MY 2025 |
| Prenatal Immunization Status (PRS-E) | MY 2024 | MY 2018 |
| Prenatal Depression Screening and Follow-Up (PND-E) | MY 2024 | MY 2019 |
| Postpartum Depression Screening and Follow-Up (PDS-E) | MY 2024 | MY 2019 |
Utilization
| Measure | Stratification Added | ECDS Only |
| * Well-Child Visits in the First 30 Months of Life (W30) | MY 2023 | n/a |
| * Child and Adolescent Well-Care Visits (WCV) |
MY 2022 |
HEDIS AND HEALTH EQUITY
To learn more about how HEDIS measures help to advance health equity, download NCQA published reports and reviews of key topics.
Learn more about the updated HEDIS SNS-E measure:
- The addition of administrative billing codes and other coding changes.
- A visual depiction of the SNS-E measure to better understand the structure and data sources.
- Answers to frequently asked questions about the SNS-E measure.
Cervical and Breast Cancer Screening: Evidence and Guidelines to Support Inclusive Quality Measures
Topics include:
- Navigating guidelines for inclusive cancer care.
- The role of data standards in inclusive measurement.
Empowering Health Care Organizations to Improve Care for LGBTQ+ Populations (September 2024)
The issue brief covers:
- The regulations outlined in the 2024 final rule from HHS.
- Why understanding these regulations is important for health care organizations.
- How health care organizations can act to better serve the LGBTQ+ community.
- Resources to further understanding of the new rule and other relevant legislation.
Health Equity and Social Determinants of Health in HEDIS: Data for Measurement
Read more about key considerations in HEDIS for assessing and advancing health equity, including:
- Definitions of frequently used terms, including terms that are often conflated or misused.
- Using HEDIS to gauge language diversity and racial/ethnic diversity among health plan members.
- Using administrative and community-level proxy data to detect social needs.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).