Digital HEDIS by MY2030: Hybrid Retirement Timeline and How Health Plans Can Prepare

What is Digital HEDIS?

Key takeaways

• NCQA will retire the HEDIS hybrid method by MY 2029. HEDIS is set to be fully digital by MY 2030.
• In January 2026, NCQA changed the path for some measures, such as prenatal care and transitions of care. Old timelines online may be out of date.
• When a measure leaves hybrid, sampling ends. You report on your whole eligible population.
• Plans need electronic data pipelines, code mapping, member matching, frequent calculations, side-by-side testing and a full audit trail.
• Several transitioning measures, like Transitions of Care, also affect Medicare Star Ratings.

Why is NCQA retiring HEDIS hybrid measures?

The hybrid method mixes claims data with a sample of medical record reviews. It was needed because claims alone could not show some care, like a blood pressure reading. That is why most plans have a busy HEDIS season every year: find members, chase charts, review them, report, and submit.

Now electronic clinical data is better and easier to get. NCQA says its goal is to move all measures to ECDS and FHIR/CQL formats to make measurement faster, more accurate, and less work, as explained in NCQA's timeline announcement.

NCQA also says it does not expect a big drop in scores when hybrid goes away, because the gap between digital-only results and hybrid results has been shrinking. But that only holds if your electronic data is complete.

HEDIS hybrid measures retirement timeline (as of September 2026)

NCQA first shared its plan in November 2024. In January 2026, it kept the MY 2029 end date but changed the path for some measures after more testing, as noted on NCQA's ECDS page. Always check that page before you plan.

Why this matters for Star Ratings

Some of these measures also count toward Medicare Star Ratings. For example, NCQA says the hybrid Transitions of Care measure is part of the CMS Star Ratings, so it is working with CMS on the change (NCQA on TRC). Blood pressure and diabetes control measures also feed Part C Stars. If your electronic data for these is weak, your ratings are at risk. See how PERFORM+ Stars helps plans track this.

NCQA is also changing how specifications are written. From MY 2026, specs follow a FHIR-aligned format (MY 2026 update). For MY 2028, NCQA plans clearer data source rules and specs that are easier to turn into computer logic (MY 2027 update).

ECDS vs Digital Quality Measures (dQMs): What is the difference?

People often mix these up. They are related, but not the same

A plan can report ECDS measures today without running FHIR/CQL logic. Over time, the two will come together.

What changes for Health Plans when hybrid HEDIS ends?

No more sampling. Once a measure leaves hybrid, you report on your full eligible population, not a sample (NCQA). Evidence that you once found in a few hundred charts must now exist electronically for every member.

You can't fix gaps with a chart pull in spring. For ECDS-only measures, clinical evidence has to come in as electronic data during the year.

Data tracking still matters. From MY 2026, NCQA no longer requires source system of record (SSoR) reporting for ECDS. But it says it is looking at new ways to check data sources (NCQA's ECDS page). Keep a clear record of where every data point comes from.

HEDIS becomes a year-round job. Today, many plans follow a fixed yearly cycle: find members in Q3, chase charts in Q4, report in Q1 and submit in Q2. As we explore in our article on Intelligent Quality Management, traditional methods leave gaps hidden for months; Digital HEDIS rewards teams that track rates all year.

How to prepare for Digital HEDIS: 6 things to build now

1. Clinical data pipelines. Bring in data from EHRs (FHIR and HL7), labs, HIEs, registries and care management systems all year, not once a year.

2. Code mapping. Map local codes to standard ones used in HEDIS value sets, like LOINC, SNOMED CT, RxNorm, CVX, ICD-10, CPT and HCPCS. Keep the original code too, so auditors can trace it.

3. Member and provider matching. Match members across plans and data sources, and providers across NPI and TIN. Unmatched data never counts toward a measure.

4. Frequent measure calculation. Run rates weekly or daily, so you can close gaps before the year ends.

5. Side-by-side testing. NCQA tests new ECDS measures next to the hybrid version before retiring the old one (NCQA). Do the same: run both and explain any differences.

6. A full audit trail. Every result should trace back to the source record and be easy to rerun for past years.

Most of this is data work. PERFORM+ DataScale is CitiusTech's data platform for these regulatory and value-based data needs.

Where does AI fit in Digital HEDIS?

Less chart review does not mean less unstructured data. A lot of clinical evidence still lives in PDFs, scanned records and doctor notes. And until each measure moves, plans still do hybrid reviews.

AI can help turn that evidence into clean, structured data. But auditors need to be able to follow it. Look for:

• confidence scores for each result
• human review queues
• a link from each value back to its source document
• tracked model versions

Check with your NCQA-licensed auditor before using AI-extracted data as ECDS supplemental data.

How PERFORM+ helps Health Plans move to Digital HEDIS

PERFORM+ is CitiusTech's quality and clinical analytics platform for health plans and provider groups.

• NCQA certified for MY 2026. NCQA's vendor list (updated 15 September 2026) shows PERFORM+ certified for all HEDIS Health Plan measures for MY 2025 and MY 2026, including Allowable Adjustments. It can also support end-to-end IDSS (Interactive Data Submission System) and XML submission.

• One engine for every method. It runs administrative, hybrid and ECDS measures, and calculates results on demand instead of in yearly batches. That is useful during the transition, when you report some measures both ways.

• Year-round tracking. Plans can run HEDIS calculations daily or weekly and spot missing care while members are still in the measurement window.

• FHIR-ready. Built-in tools for FHIR data exchange help share care gaps with providers and connect to EHRs.

• Built on Databricks. PERFORM+ is a Databricks partner solution that brings clinical, claims and financial data together.

• GenAI for HEDIS. In August 2024, CitiusTech launched what it calls the industry's first Generative HEDIS solution in PERFORM+. It turns plain-language requests into measure rules and helps abstractors pull evidence from PDFs and notes.

• Proven results. A leading Blue plan improved gap closure by 30% with PERFORM+. A California health plan uses it for weekly compliance reporting and NCQA submissions. CitiusTech also built a real-time HEDIS engine on Azure for a large Blue plan covering 1 million people.

Frequently Asked Questions

1. When will HEDIS be fully digital?

   NCQA aims to make HEDIS fully digital by MY 2030 and retire the hybrid method by MY 2029.

2. Which HEDIS measures became ECDS-only in MY 2026?

   Lead Screening in Children, Statin Therapy for Patients with Diabetes and Statin Therapy for Patients with Cardiovascular Disease.

3. What is new for ECDS in MY 2027?

   Plans can report Glycemic Status Assessment for Patients with Diabetes (GSD-E) through ECDS on a voluntary basis. ECDS measures are also now grouped by clinical area.

4. Is ECDS the same as a Digital Quality Measure (dQM)?

   No. ECDS is a way to report electronic clinical data. A dQM is a measure written in FHIR and CQL so software can run it.

5. Will HEDIS scores drop when hybrid ends?

   NCQA does not expect a large drop overall. But plans that still rely on chart review for some measures could see lower rates if their electronic data has gaps.

6. What does NCQA Measure Certification mean?

   It confirms that a vendor's HEDIS software calculates measures correctly. It is given for each measurement year and a set scope, so check both on NCQA's latest vendor list.