What Health Plans Need to Know About HEDIS Measurement Year 2027
After each yearly HEDIS submission is completed, NCQA releases new draft updates to HEDIS and every year, quality and analytics teams brace for the fire drill. The MY 2027 update is comparatively light—but “light” doesn’t mean “nothing to plan for.” Here’s what’s changing and what it means for your quality strategy.
Six new measures are entering the mix
MY 2027 introduces six new measures, meaning NCQA will collect data throughout the measurement year before deciding whether they graduate to public reporting:
- Follow-Up After Positive Colorectal Cancer Non-Invasive Screening Test (COF-E) - tracks whether members get timely colonoscopy follow-up after a positive stool-based screen.
- Prenatal Syphilis Screening (PSY-E) - screens for infection early in pregnancy to reduce congenital transmission.
- Continuous Glucose Monitoring Utilization (CGD-E) - tracks CGM use among members on insulin therapy. The practical takeaway for anyone on the payer or health-IT side: the work to do now is inventorying CGM data sources and confirming DME and pharmacy claims can be reliably joined at the member level, since that’s the gating factor on reporting rather than anything clinical.
- Person-Centered Outcome, Goal Identification (GID-E) – new for Medicare D-SNP and C-SNP members with complex care needs.
- Person-Centered Outcome, Goal Follow-Up (GIF-E) – measures whether members follow up on the individualized goal they set.
- Person-Centered Outcome, Goal Achieved (GIA-E) – measures whether members ultimately achieve their goal.
That last group is worth pausing on. Person-centered outcome measures shift HEDIS further toward goal-based, individualized care. In NCQA’s own words, these measures “support whole-person care by aligning care delivery with individual goals and preferences.”
Ten measures are on notice
NCQA has flagged 10 measures as candidates for retirement, pending public comment and Committee on Performance Measurement approval. If finalized, they’ll disappear from reporting when the Volume 2 Technical Update publishes in March 2027 and the specifications are frozen.
- Documented Assessment After Mammogram (DBM-E)
- Oral Evaluation, Dental Services (OED)
- Topical Fluoride for Children (TFC)
- Diagnosed Mental Health Disorders (DMH)
- Diagnosed Substance Use Disorders (DSU)
- Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
- Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
- Use of Opioids at High Dosage (HDO)
- Risk of Continued Opioid Use (COU)
- Language Description of Membership (LDM)
The list is largely measures NCQA cites as having limited actionability, small populations, or overlap with other measures.
The takeaway for quality teams: don’t over-invest in remediation work for these measures this cycle without first confirming their final status.
A few measures got real updates
Three existing measures saw substantive changes:
- Pharmacotherapy Management of COPD Exacerbation (PCE) got the most significant overhaul in this release and will be in first year status for MY 2027
- Adult Immunization Status (AIS-E) revised its pneumococcal vaccination age band, now capturing 50–64 years as well as 65 years and older.
- Emergency Department Utilization (EDU) added Medicaid as a reportable line of business for the first time. Medicaid reporting will be in first-year status for MY 2027.
The ECDS shift continues
GSD-E’s introduction is part of a bigger trend: NCQA continues moving measures toward Electronic Clinical Data Systems reporting. This cycle, NCQA also reorganized every ECDS-reported measure by clinical domain rather than grouping them separately—so, for example, Breast Cancer Screening (BCS-E) now sits in the Prevention and Screening domain instead of a standalone ECDS section. It’s a filing-cabinet change more than a specification change, but it will shift where teams look for these measures in Volume 2.
Smaller changes with real reach
A handful of adjustments touch measures across the board:
- Race and ethnicity stratification categories were revised to capture declinations and unknowns more precisely.
- Death and palliative care exclusion criteria were clarified and expanded.
- Terminology was updated in a few places: “chemical dependency” is now “substance use disorder treatment,” and risk-adjustment measures now spell out “condition category” and “hierarchical condition category” instead of using CC/HCC shorthand.
None of this changes what plans need to do, but they do change what your specs, code, and reporting language need to say.
What this means for MY 2027 planning
Compared to some past cycles, this is a manageable list. But manageable doesn’t mean passive. Quality and analytics teams should:
- Confirm final status on the 10 retirement candidates before reallocating resources away from them.
- Scope the new first-year measures early—they may require data capture that plans may not currently have workflows for.
- Update terminology and stratification logic across affected measures, even where the underlying calculation didn’t change.
- Watch PCE, AIS-E, and EDU closely if those measures are part of your existing quality programs.
“Every HEDIS cycle asks quality teams to separate the changes that matter operationally from the ones that are just administrative,” said Catherine Wormington, Payer Strategy, Veradigm. “MY 2027 is a good reminder that even a relatively ‘light’ year has a few items that may require work and dataflow changes, not just spec updates.”
Veradigm’s Gap Closure Services and Quality Analytics teams help health plans translate HEDIS updates like these into measure-ready workflows, before they become audit-season surprises. Talk to a quality expert today.