Re-Thinking Our Approach to Population Health

NCQA’s Wellness and Health Promotion Accreditation and Certification program has been in place for more than a decade, helping organizations design programs that engage people in improving their health. In 2025, NCQA started the Innovations in Wellness and Condition Management Working Group to update the program to reflect best practices and new technologies for evaluating population risk and providing self-management and coaching to help improve health outcomes. This is part of a larger effort to evaluate how high-quality, effective population health services are delivered across NCQA programs.

“As an industry, we have an opportunity to redefine our approach to population health and how we prevent and manage chronic disease,” says Rachel Harrington, PhD, NCQA’s Senior Product Strategist. “We know that 40-60% of the factors that influence a person’s health come from outside the walls of the healthcare system. With limited resources, especially in primary care and behavioral health, it is important to help support people in managing their health, including the use of digital technologies.”

In 2026, NCQA will start shaping these new standards, focusing on evaluating outcomes and supporting confident decision-making on digital health and wellness solutions. This isn’t just a focus for NCQA. “It’s validating to see that our work aligns with the CMS Innovation Center’s new ACCESS model,” says Harrington. “We hope it will motivate organizations to innovate and improve the patient experience.”

Understanding Health Differences Within Populations and Communities

Improving population and community health requires organizations to identify variations in health outcomes, look for the root causes and target solutions to populations and communities. The upstream, structural and personal factors that drive differences in health outcomes are complex and multifaceted—and often require data, investments and partnerships broader than the healthcare system. NCQA’s Accreditations in Health Outcomes and Community-Focused Care give organizations a framework to understand differences and close gaps.

“We’ve updated our program to give organizations more ways to view population and community health and a greater ability to tailor the program to the areas most relevant to the populations they serve,” says Elizabeth Ryder, NCQA’s Assistant Director, Product Management. “For example, disability status is a new population focus for Health Outcomes Accreditation, which complements a new HEDIS^® measure that we introduced in measurement year 2026.”

Listen to our podcast, One in Four: Making Disability a Quality Priority, to learn more about these changes.

Shaping the Future of Primary Care

Primary care is evolving at an astounding pace. NCQA’s Patient-Centered Medical Home Recognition program laid the foundation by providing an operational and quality improvement framework for primary care. Now, we are helping practices advance their relationships with payers and succeed in value-based care.

“We are looking at the next horizon for primary care,” says Jeff Sitko, NCQA’s Assistant Vice President, Product Management. “We have an opportunity to create a best practice, scalable delivery model that provides a blueprint for primary care practices to continue developing their capabilities. We want to work side-by-side with practices to understand what’s valuable and realistic, while also reducing administrative burden.”

Stay tuned for an announcement about our primary care partners. In the meantime, listen to our Quality Matters podcast, What’s New and What’s Next for Primary Care.

Integrating Primary Care and Behavioral Healthcare

People with mental health conditions and substance use disorders are more likely to experience chronic health conditions like heart disease and diabetes. Similarly, people who are living with chronic conditions may struggle with depression or anxiety. Integrated care models that combine behavioral health and primary care can improve access and coordination, leading to better health outcomes.

“We need more care delivery models that support whole-person care,” says Julie Seibert, PhD, NCQA’s Assistant Vice President, Behavioral Health. “Integrating behavioral health and primary care can improve access and coordination of care by meeting people where they are and implementing a ‘no wrong door’ policy when it comes to accessing behavioral health services.”

In 2026, NCQA will continue to promote integration, with funding from the Health Resources and Services Administration, to support Federally Qualified Health Centers and Look-Alike Health Centers seeking NCQA’s Distinction in Behavioral Health Integration.

We’ve also updated our Behavioral Health Accreditation program to strengthen the focus on population health and network adequacy. Read our blog post, Behavioral Health Accreditation Promotes Accountability, to learn more.

Advancing the Transition to Digital Quality Measurement

The transition to digital quality measurement is accelerating as healthcare moves rapidly toward interoperability and real-time data exchange. Most HEDIS measures are available in a digital format, ready for implementation. From building CQL engines to integrating digital measures at the point of care, organizations are making progress and showing tangible results.

“The year 2030 is our north star to become fully digital, and industry alignment is critical for success,” says Tricia Elliott, NCQA’s Vice President, Quality Implementation. “There are three parallel tracks that need to converge for us to continue forward progress: updates to the CMS Digital Quality Measures Roadmap, conversion of data to the HL7^® FHIR^® standard and clarity on the use of USCDI Core versus USCDI QI Core standards. The more we can build alignment, the easier it will be for everyone to do the work we need to do by 2030.”

In 2026, we anticipate broader adoption of digital HEDIS measures, supported by certification and parallel testing. NCQA recently launched a Digital Quality Measure Evaluation Package that includes a sample of digital HEDIS measures and supporting tools to help explore, test and plan your transition with confidence. Our Digital HEDIS Directory highlights how organizations are using NCQA’s digital HEDIS measures to modernize care delivery, drive efficiencies and improve outcomes.

Visit NCQA’s Digital Quality Hub for more resources to support your transition.

Expanding Use of Clinical Data in HEDIS^®

HEDIS is evolving to provide a more complete picture of care for populations, enabled by increased integration of clinical data. In Measure Year  2026, we will implement six new Electronic Clinical Data Systems (ECDS) measures and three measures will transition to ECDS-only.

“While every organization is on its own journey in incorporating clinical data, what remains constant is the trust in a reported HEDIS rate,” says Taylor Musser, NCQA’s Director, Measure and Data Operations. “This is driven in part by the audit requirements holding all organizations to the same expectations for data contributing to HEDIS. While a measure may be new or updated, the HEDIS Compliance Audit^™ helps to ensure an apples-to-apples comparison as HEDIS evolves.”

Read our blog post, HEDIS MY 2026: What’s New, What’s Changed, What’s Retired, to learn more about what you can expect in 2026.

Improving Quality of Care for Patients with Cardiovascular-Kidney-Metabolic Syndrome

NCQA conducted three expert convenings in 2025 to gather insights and help define our quality measurement approach related to Chronic Kidney Disease and Cardiovascular-Kidney-Metabolic (CKM) Syndrome. We are excited to accelerate this work in 2026.

“We’re interested in exploring quality measures that focus on risk assessment and prevention because if you can prevent one of these CKM-related diseases, you can often prevent them all,” says Caroline Blaum, MD, NCQA’s Assistant Vice President, Chronic Conditions and Complex Care. “I anticipate that 2026 will be a year of significant progress as we define our measurement approach and begin testing with real-world data.”

NCQA recently released a white paper that synthesizes what we learned from the convenings and makes recommendations for a holistic approach to the prevention and management of CKM syndrome.

Defining High Quality Diabetes Care

Diabetes is one of the diseases intertwined within the CKM framework. NCQA’s Diabetes Recognition Program recognizes clinicians who use evidence-based measures to provide high-quality care to patients with diabetes. We added three new measures to the program for 2026: Statin Therapy Prescription, Depression Screening and Follow-Up and Continuous Glucose Monitoring (CGM) Utilization. The CGM Utilization measure is the first step toward understanding and quantifying the growing use of this technology.

“The new CGM Utilization measure will help us understand where the technology is being used, which populations are using it and whether there are barriers limiting adoption,” says Emily Hubbard, MPH, NCQA’s Senior Research Associate. “Our goal is to standardize the data to help organizations capture and report on utilization within a defined population of patients with diabetes. This effort will lay the groundwork for NCQA to develop a broader CGM performance measurement approach in the future.”

Learn more about recent updates to the Diabetes Recognition Program, or access the standards in the NCQA store.

Reducing the Administrative Burden of Utilization Management

NCQA continually evaluates its standards and programs to ensure they remain relevant and useful for the industry. This includes reducing administrative burden so organizations can focus on what matters most: providing high-quality, accessible care. Interoperability is the key to transforming cumbersome processes, like prior authorizations.

“In 2026, we will start to see the impact of the CMS Interoperability and Prior Authorization Final Rule, which should make the process less burdensome and more efficient,” says Tsveta Polhemus, NCQA’s Assistant Vice President, Product Management. “NCQA’s revised utilization management standards are tightly aligned with the federal rules, and extend beyond them, as we also include commercial plans. We provide guidance to help plans analyze denial and appeal rates to identify what’s working and what’s not so they can provide a better experience for clinicians and patients.”

Read our blog post, Breaking Down Silos in Utilization Management: A Data-Driven Approach, to learn more about the updates to NCQA’s utilization management standards.

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

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

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

The post NCQA’s 2026 Trends to Watch appeared first on NCQA.

Real-time Visual Notes created by Ink Factory.

The conversation continues at the Health Innovation Summit with an inspiring keynote session on reducing health disparities. Moderator Tamara Thomas of Aledade joined Donald Erwin and Alexandria Johnson of St. Thomas Community Health Center and Danielle Brooks of AmeriHealth Caritas to discuss practical, data-driven approaches to reducing health disparities.

“Our session is called Disrupting Disparities: Playbooks for Change. But we’re not talking about football plays—we’re talking about saving lives and doing so inclusively,” says Thomas. “When we think about the importance of these playbooks, it is much like football. You need to have a strategy, you need to have teamwork and sometimes you need to have the courage to call a different play when the old ones aren’t working. And today in health care, we need some new plays.”

How Collecting Data Helped Uncover Patient Needs

St. Thomas Community Health Center is a federally qualified health center (FQHC) in New Orleans that serves more than 22,000 patients each year across seven clinics. It has also earned NCQA’s Patient-Centered Medical Home Recognition.

Reducing No-Show Rates

In 2021, the no-show rate for appointments at St. Thomas was 35%. The team tried emails, text reminders and phone calls to patients, but nothing seemed to make a difference. They decided to start collecting data to understand what patients really wanted. Every time a patient requested an appointment, the staff noted the date they wanted to be seen, the practitioner they wanted to see and the type of appointment.

When they looked at the data, they identified a significant gap: 40% of patients wanted same-day care and 22% wanted next-day care, but St. Thomas had 3-4 week wait times for primary care appointments. The team made a drastic change to their scheduling practice to accommodate same-day and next-day care and the no-show rate decreased from 35% to 15%.

Improving Clinic Wait Times

Next, the team decided to tackle wait times in the clinics. “For our patient population, it’s crucial that we run on time because they have to get back to work or they have to get back to their children,” says Johnson. “When our clinic runs late, we force our patients to choose between getting the medical care they need or making sure they keep their job or meet their kids’ needs.”

Once again, the team at St. Thomas looked at the data: How long patients sat in the waiting room, how long it took to triage them, how long the patients waited to see the provider. And they found opportunities to improve at every step along the way. For example, they found that patients spent an average of 19 minutes with a practitioner, but appointments were only scheduled for 15 minutes. By extending scheduled appointment times to 20 minutes, they were able to improve timeliness.

“Patients are the experts in their own health care. If you listen to their voices clearly enough, you’re going to get a healthy dose of humility because they know what they’re talking about,” says Erwin. “They’ve told us a hundred times: ‘Stop trying to think for us.’ ‘Stop trying to think about what we want, or what we should want.’ So, we’re listening. And we still work every day to earn the trust of the folks in our community.”

The Power of Partnerships

Too often, health care operates in silos. Having opportunities to partner with industry stakeholders and the community can provide context to see if the solutions we are developing will actually work. Brooks shared her experience participating in NCQA’s Perinatal Health Measurement Advisory Panel, which gathered a wide range of perspectives—payers, care delivery organizations, patients, doulas, advocates—to focus on developing perinatal health measures from a perspective of lived experience.

“Data is wonderful, but data is imperfect and there can be bias in data,” says Brooks. “I can look at as much data as I want, but I also need that context and quantitative learning that comes from listening to the stories of the people in the room.”

Brooks also stressed the importance of viewing health care policy in a historical context. “These disparities are real. We can choose to act on them now, or they’ll get worse over time,” says Brooks. “What may be the policy today, may not be tomorrow. We need to continue to focus on communities, to take solace and learn from those that have gone before us.”

Donald Erwin Receives NCQA’s Health Quality Award

NCQA’s Founder and President, Peggy O’Kane made a surprise appearance at the end of the keynote session to present Erwin with the Health Quality Award. O’Kane first met Erwin when she visited New Orleans in the aftermath of Hurricane Katrina. The two worked closely together in the years that followed, helping to increase the number of FQHCs and patient-centered medical homes in Louisiana, and improving access to care for uninsured and under-insured people.

“My visits to St. Thomas were among the most moving experiences I’ve had in my career,” says O’Kane. “Donald Erwin is a true servant leader. He has dedicated his career to the pursuit of high-quality care for all—especially those who are too often left behind due to barriers in access, health status or lived experience. His tireless work, collaborative spirit and visionary leadership have improved countless lives. I am privileged to recognize him and his team’s work.”

Join Us Next Year

Mark your calendar for the 2026 Health Innovation Summit, October 4-7, in Atlanta, Georgia!

The post Disrupting Disparities With Data—And a Focus on Community appeared first on NCQA.

Want to know who’s coming to the Summit? View the attendee list (by company name and title) here.

New! Poster Presentations

For the first time, the summit will feature a poster showcase—a spotlight on eight pioneering organizations that are improving health care quality. You’ll meet the leaders driving this critical work, and discover practical solutions to apply at your organization.

Poster presentation topics include:

• Advancing Behavioral Health Equity: Innovative Tools for Data-Informed Clinical Design
• Assessing Healthcare Disparities Using a Recently Developed Health Plan Quality Measures Index
• AI-Powered Predictive Interventions and Hyper-Personalization: A Revolution in Diabetes Care Management
• Data-Driven Strategies to Align Engagement, Results & ROI in Whole-Person Care for Vulnerable Groups
• Improved Transition of Care Guidance for Dually Eligible Populations

Don’t miss this unique opportunity to experience health care quality innovation up close. View all the poster presentations here.

Spotlight Presentations

Explore the future of health care quality innovation with spotlight presentations—dynamic, concise, power-packed talks happening in the Digital Innovation Theater.

Spotlight presentations include:

• Unlocking Quality Performance: Addressing Unmet Needs in Health Plan Care Management
• Lessons Learned on the Road to Digital Quality Reporting
• Trust Matters: Powering High-Quality, Validated Clinical Data
• Don’t Waste Another Day on Manual Gap Closure
• Quality in Sync: Closing Gaps and Boosting Performance With AI
• From Data to Equity: Powering Whole-Person Health Through AI and Integrated Care

View all the spotlight presentations here.

Meet the Experts

NCQA subject matter experts will be available for interactive discussions, offering a unique opportunity to gather insights about NCQA programs.

Join Us in San Diego!

Register today to spend three days with leaders in the quality ecosystem and engage with innovators transforming the health care industry. Book your room at the Gaylord Pacific Resort & Convention Center by September 19 to lock in the NCQA rate.

Groups of three or more enjoy special discounted pricing. Invest in your team’s growth while saving on registration. Please contact us for help with group registration.

The post Connect and Engage at the 2025 Health Innovation Summit appeared first on NCQA.

“Presenting at the AcademyHealth ARM allows us to share our research with thought leaders from around the country, and get their feedback and reactions,” says Rachel Harrington, NCQA’s Senior Product Strategist. “This event demonstrates the power of collaboration and dialogue within the research community.”

Putting Quality Into Practice

NCQA’s research isn’t just theoretical—it’s grounded in the realities health care organizations face every day. “We’re not testing ideas in a vacuum,” Harrington explains. “We’re focused on what works in practice.”

Race and Ethnicity Data Collection. Harrington joined a panel to discuss how NCQA is adapting its HEDIS^® and Accreditation programs in response to updated federal standards for race and ethnicity data collection. Updates for HEDIS MY 2026 were recently announced in our blog.

Social Needs Screening. NCQA evaluated social needs screening and intervention rates for more than 500 commercial and Medicaid plans, and identified barriers that limit adoption: lack of standardized screening questions, challenges transferring data from HIEs to health plans, inconsistent state and federal policy guidance and incentives.

• View the poster: Improving Policy and Systems for Social Needs Measurement: Key Insights from First Year of National Health Plan Performance.

Person-Centered Outcome (PCO) Measures. Our latest research compares implementation of PCO measures in Certified Community Behavioral Health Clinics (CCBHC) and long-term services and supports/primary care settings (LTSS/PC) including 197 clinicians and 7,867 patients. We found that CCBHCs performed well in goal identification, while LTSS/PC achieved better follow-up and goal achievement. Staff turnover was a barrier to implementation in all settings.

• View the poster: Distinct Pathways: Comparative Analysis of PCO Implementation Outcomes in Certified Community Behavioral Health Clinics and Long-Term Services and Supports/Primary Care Settings.

Partnering With The Community to Improve Care for People with Disabilities

NCQA is focused on ways to define and enable high-quality care for people with disabilities. Our research highlights the importance of partnering with community-based organizations to help ensure that all community members have a voice in health care quality.

Julie Seibert, NCQA’s Assistant Vice President, Behavioral Health, spoke on a panel about NCQA’s role in an IEC (Institute for Exceptional Care) project to develop a quality measurement framework to address persistent health inequities among people with intellectual and developmental disabilities (IDD). “With more than 200 stakeholders, this project is a perfect example of community engagement in action,” says Seibert. “NCQA is honored to be a part of this initiative to identify quality measures that focus on the things that matter most for people with IDD and their families.” Read our blog to learn more about this important work.

NCQA also presented research on quality measurement priorities for people with disabilities and the current status of disability data collection in health care settings. The key takeaway: We need to work toward improving and standardizing data collection if we want to understand the needs and challenges to accessing care that people with disabilities face.

• View the poster: Current State of Disability Status Collection in Health Settings.
• Read the article: Improving Care for People With Disabilities Starts With Collecting Data.

Improving Outcomes for People with Chronic Conditions

Helping people manage chronic conditions can improve their quality of life, and reduce health care utilization and costs. NCQA’s research identifies gaps between clinical practice guidelines and current care delivery models where health care organizations can focus quality improvement efforts.

Delivering Better Asthma Care. NCQA found that, among a sample population of Medicaid and commercial plan members with asthma, fewer than half received timely follow-up care after an emergency department visit. Follow-up rates (including outpatient or telehealth visits within 30 days) varied by race, gender, COPD comorbidities and socioeconomic factors. This research informed NCQA’s new HEDIS measure, Follow-Up After Acute Care and Urgent Care Visits for Asthma (AAF-E), which encourages guideline-based health care utilization for asthma as a starting point for delivering better care.

• View the poster: National Trends in Post-ED Follow-Ups for Asthma.

Harrington also moderated a panel, Randomized Evaluations to Improve Care Delivery: From Deprescribing Tools to Collaborative Dementia Care. “This panel was an opportunity for NCQA to be part of a larger dialogue about making the health care system safer and more effective,” says Harrington. “When health plans and health care delivery systems collaborate and share their unique perspectives on quality improvement, everyone benefits.”

The Future of Quality

NCQA’s research is pushing boundaries and defining the future of quality, and that includes assessing the environmental impact of health care. The health care sector accounts for 8.5% of all greenhouse gas emissions, but is less engaged in reducing its carbon footprint than other industries. NCQA developed the Resilient Health Systems model to guide climate health initiatives within health care organizations.

“This framework integrates climate sustainability and resilience as a core outcome of health care quality—a distinction increasingly recognized by health care stakeholders as critical to overall system performance and readiness for long-term impact on health,” said Adrianna Nava, Applied Research Scientist for Quality Sciences.

Health plans can accelerate progress by focusing on strategies within their control and developing clear accountability models.

• View the poster: The Resilient Health Systems Model: Practical Actions for Health Plans to Reduce Carbon Footprints.

Work With Us!

NCQA welcomes and appreciates support from corporations and foundations that share our values and want to join us to advance our mission to improve the quality of health care. For more information about partnership opportunities, contact Erin Oganesian, AVP, Corporate & Foundation Relations at eoganesian@ncqa.org.

The post NCQA Researchers Share Findings on Emerging Topics in Health Care appeared first on NCQA.

The summit is your opportunity to:

• Join conversations about today’s most pressing health care quality issues.
• Connect with subject matter experts, during and after sessions, for deeper learning.
• Take part in guided discussions that foster collaboration and actionable ideas.
• Network in the relaxed settings of the Opening Reception and Business Lounge.

Keynote Speakers at the Health Innovation Summit

This year’s summit features a powerhouse lineup of keynote speakers who are driving innovation and shaping the future of health care. Their sessions will dive into the most pressing and transformative topics in the industry.

Don’t miss this chance to hear from leading voices in health care quality.

Reinventing Quality in a New Era of Care

Find out how quality measurement will evolve to support a more proactive, sustainable health system—one that prioritizes prevention, improves chronic disease management and meets the complex needs of an aging population.

Keynote Speakers

• Dana Erickson, President and CEO, Blue Cross and Blue Shield of Minnesota
• Mark McClellan, MD, PhD, Director, Duke-Margolis Institute for Health Policy; Former CMS Administrator and FDA Commissioner
• Margaret O’Kane, President, NCQA
• Marc Overhage, MD, PhD, The Overhage Group; Member, NCQA Board of Directors

The Trust Layer: Building Confidence in AI Through Standards

This session brings together industry stakeholders to discuss the critical “enablement layer” of AI, and how to bridge innovation, measurement and accountability in AI-driven health care.

Keynote Speakers

• Maia Hightower, MD, MPH, MBA, CEO & Founder, Veritas Healthcare Insights; CEO & Founder, Equality AI
• Aaron Neinstein, MD, FAMIA, Chief Medical Officer, Notable Health
• Josh Wymer, Chief Health Information & Data Strategy Officer, State of Missouri Health Data Consortium

Disrupting Disparities: Playbooks for Change

Explore practical solutions for addressing health disparities through data collection, screening protocols and lessons learned. Discover how targeted strategies and real-world insights can drive meaningful improvement for all.

Keynote Speakers

• Danielle Brooks, JD, Corporate Director, Health Equity, AmeriHealth Caritas
• Donald Erwin, CEO, St. Thomas Community Health Center
• Tamara Thomas, National Vice President, Equity & Inclusion, Aledade

Setting the Bar: Quality and Impact in Behavioral Health Innovation

With rising behavioral health needs and ongoing workforce shortages, technology is helping bridge critical gaps. This discussion will explore how to uphold—and even elevate—standards of care in a rapidly evolving digital landscape.

Keynote Speakers

• Katherine Hobbs, MD, MPH, CEO, Author Health
• Kate McEvoy, Executive Director, National Association of Medicaid Directors
• Geoffrey Neimark, MD, Chief Medical Officer, CCBH

The Next Frontier in Caring for the Whole Person

This session explores innovative approaches that break down silos, foster collaboration and drive better outcomes for patients with complex health needs. Join experts as they discuss the future of quality and its role in enabling a holistic, person-centered approach to care.

Keynote Speakers

• Sachin H. Jain, MD, MBA, President & CEO, SCAN Health Plan
• Julie Murchinson, Partner, Transformation Capital

The Road To Digital Quality: Why It Is Worth the Drive

The road to digital quality in health care is full of detours, roadblocks and tricky intersections. This session will help you see the destination more clearly—and map a course to deliver real value for patients.

Keynote Speakers

• David Kendrick, Chief Executive Officer, MyHealth Access Network, Inc.
• Bharat Sutariya, Senior Vice President & Chief Health Officer, Oracle Health

View the entire list of sessions here.

Join Us in San Diego!

Spend three days with leaders in the quality ecosystem, and make valuable connections with innovators transforming the health care industry. Whether you’re attending for the first time or returning, you’ll leave energized—with new strategies, perspectives and partnerships to elevate your work.

Save $200+ if you register by September 5. Book your room at the Gaylord Pacific Resort & Convention Center by September 19 to lock in the NCQA rate.

The post A Powerhouse Lineup of Keynote Speakers at the Health Innovation Summit appeared first on NCQA.

Currently, the teams are seeking testing partners—health plans, health systems, state agencies, community-based organizations, Federally Qualified Health Centers, birth centers—to help evaluate the feasibility, validity, reliability and usability of the new measures through a learning network, beginning this fall.

Perinatal Measure Development Process

Between 2022 and 2023, the project team conducted an environmental scan to establish a perinatal health measurement strategy. The team then developed a perinatal health and health equity measurement framework to highlight areas that can support birthing care and identify entities that should be held accountable.

With support from a measurement advisory panel and perinatal health experts who provide ongoing feedback and direction, the project team identified and prioritized four focus areas of health during pregnancy and postpartum:

1. Hypertensive disorders.
2. Anxiety and depression.
3. Health-related social needs.
4. Timely and adequate prenatal and postpartum care.

The team plans to undertake two measure development cycles, testing and developing four measures in each cycle. The first will occur between 2025 and 2026, the second between 2026 and 2027.

Introducing the Reproductive Health Learning Network

Measure testing is a key component of the HEDIS measure development cycle for evaluating the importance, feasibility, validity, reliability and usability of each measure. The project will go a step further by building a collaborative learning network.

The project is seeking testing partners from:

• Health plans.
• Hospitals and clinical health systems.
• Community-based organizations.
• Federally Qualified Health Centers.
• State agencies.
• Birth centers.

To apply to join the Reproductive Health Learning Network, fill out our non-binding Learning Network Application Interest Form.

About the Learning Network

Length of Commitment. Testing partners commit to working on the project from October 2025 to September 2026, at a minimum. Contracting will begin this fall. The first data pull will be due in April 2026, and all final data pulls will be due by August 2026.

Honorarium. Yes. Additional information will be provided at the time of contracting.

Participation Requirements. Testing partners will submit de-identified patient data on a specific metric for their entire maternal population, at a minimum, and are also required to participate in focus group sessions.

Note: Testing partners will not be required to provide data across all measure concepts. Submission of additional data may be requested on an ad hoc basis, but is not required. Submission of qualitative data (e.g., surveys, internal interviews, focus groups) is not required, but would be appreciated.

Expectations for Learning Network Participants

The table below outlines the requirements for testing partners. Multiple individual and group checkpoints will be built into the schedule.

NCQA Guidance and Support for Testing Partners

NCQA will provide consistent support to testing partners throughout the testing process:

• Create safe spaces to engage in challenging conversations and reasoning about data, measurement, perinatal health and health equity.
• Help partners establish meaningful connections with other partners and key stakeholders to promote perinatal health and health equity.
• Provide detailed and ad hoc technical assistance for measure reporting as testing partners navigate early adoption and reporting.

To join the Reproductive Health Learning Network, fill out our non-binding Learning Network Application Interest Form. Thank you for your interest!

The post Join the Reproductive Health Learning Network appeared first on NCQA.

Here are some highlights and key takeaways from the forum’s second day.

Maryland’s Policy Landscape: Top Priorities

Maryland is striving to improve health equity, maternal and child health outcomes and population health. A panel of experts discussed programs on the horizon and the challenges ahead.

Key Takeaways

Programs generating excitement:

• Affordability initiatives.
• Advanced primary care and the shift from volume to value.
• Prenatal risk assessment and performance improvement project for Medicaid managed care organizations.

Areas where Maryland struggles:

• Pre-deductible coverage to tackle affordability issues—what’s the benefit of having health insurance if people can’t afford to use it?
• Health literacy, rebuilding trust in communities and connecting people to services.
• Perinatal health and racial disparities in death rates of moms and babies.

Insights from the panel:

• Public health is more important than ever—access data from public health departments, identify shared priorities and measure what matters.
• Social determinants of health continue to drive disparities. “The choices we make are the choices we have.”

Data Sharing to Address Social Needs

Addressing whole-person care requires strong connections across the health care system. Pennsylvania has built an effective statewide social needs platform to facilitate data exchange among health care and community-based organizations.

Key Takeaways

• PA Navigate is a statewide tool for social needs screening and referrals to community resources (food, shelter, transportation and more).
• The state encourages providers to screen for social needs and to work with managed care and community-based organizations to meet community needs.
• Health information organizations—regional HIEs in Pennsylvania—work with providers and managed care plans to facilitate data sharing.
• The biggest roadblock is interoperability and data standardization—statewide guidance would help.

Building a Statewide HIE: Lessons Learned

CRISP is Maryland’s state-designated HIE. We learned how it functions, data challenges the team encountered and plans for enhancement.

Key Takeaways

• CRISP leverages a master person index to link data across systems to support care delivery and coordination, population health reporting, public health and more.
• Integrating clinical, social needs and administrative data led to decreases in ED use, duplicate testing and mortality rates.
• Not all use cases require the FHIR^® data format—simpler methods of information exchange work for many.
• Clinical data quality is a challenge and requires data mapping to standardize the data.
• Future plans include exploring low-risk administrative use cases for AI.

Innovating to Address Health Disparities

Addressing disparities in care requires creativity and innovation. Our panel shared its perspective on the risks and opportunities of leveraging AI, and the impact on communities.

Key Takeaways

AI can improve community health and well-being of communities—but we can’t overlook the ethical considerations:

• Automation and the elimination of jobs at the lower end of the social economic spectrum.
• The need to upskill the workforce to correspond with digital health solutions.
• The energy infrastructure needed to store, use and analyze AI data in communities.

As we innovate, it is crucial to reflect, act intentionally and be aware of the downstream impact on communities.

Using Data to Understand and Act to Address Health Disparities

Identifying health disparities is the first step—transforming insights into action is where real impact happens. Our panel explored data-driven methods to help organizations identify and address gaps in care at the population and individual levels.

Key Takeaways

• Community-based organizations are essential partners in reducing health disparities.
• Start small with a defined population, share lessons learned through regular feedback loops, leverage technology to support referrals and outcomes measurement.
• The importance of community-based intelligence: combining data with on-the-ground feedback from community organizations and patient experiences.
• Emphasize agency and empowerment when working with underserved communities, and amplify local voices: universities, health departments, neighborhood associations, community members.

Learn More

Read more updates from the Health Quality Forum:

• Health Quality Forum Opening Remarks: “We Must Raise Our Ambitions”
• Health Quality Forum, Day 1 Wrap Up: Virtual Care, Rural Access and More

View and download the visual note boards from the event. Below is a sample.

Real-time Visual Notes created by Ink Factory.

The post Health Quality Forum, Day 2 Wrap Up: State Innovations, Social Needs Data and Reducing Disparities appeared first on NCQA.

We’re bringing industry leaders together to collaborate and share best practices for some of the most pressing issues in health care quality: virtual care, rural access, maternal health, disability services and more.

Featured Speakers

The Health Quality Forum brings together influential voices in health care to share actionable strategies to reduce health disparities and create healthy communities. This year’s lineup features leaders shaping health policy, innovation and care delivery—all while navigating an ever-changing environment.

Meena Seshamani, MD, PhD
Incoming Secretary of the Department of Health for Maryland

With a background in both policy and practice, Dr. Seshamani is driving statewide initiatives that prioritize health equity and quality. Learn about Maryland’s innovative approach to creating more inclusive health care policies.

Don’t miss her session: The State of Health Care Quality Today: A Fireside Chat with Peggy O’Kane and Meena Seshamani, MD, PhD.

Ann Mond Johnson
CEO, American Telemedicine Association   

An advocate for expanding virtual care, Ann has played a pivotal role in shaping policies that enhance health care accessibility. Join her as she discusses the future of telehealth and its critical role in bridging today’s health care gaps.

Be sure to catch Ann’s insights at: Virtual Care: Patient Access and Choice.

Dr. David Kelley
Chief Medical Officer, Pennsylvania Department of Human Services, Office of Medical Assistance Programs

A champion of Medicaid transformation, Dr. Kelley has spearheaded initiatives to improve access and outcomes for underserved populations and create more equitable health care systems. He provides clinical oversight of the HealthChoices program, which serves more than 2.9 million people.

Get his expert perspective at: Building Toward Efficient and Effective Data Sharing to Address Social Needs.

Djinge Lindsay, MD, MPH
Chief Medical Officer, Maryland Department of Health

With more than 15 years of experience in health care and population health management, Dr. Lindsay is focused on designing systems to drive quality, value and equity. She leads the Office of Care Transformation, including Maryland’s value-based advanced primary care programs.

Hear her thoughts on navigating the current environment in the keynote session: Policy Landscape: Success and Priorities in the State of Maryland.

Jacqueline Ortiz, MPhil
VP of Health Equity, ChristianaCare

Jacqueline is a leader in cultural competence, helping to ensure that health care systems address diverse patient needs. Hear how inclusive care practices improve patient outcomes and reduce disparities.

Join her for a thought-provoking discussion in: Going Beyond Community Health Needs Assessment to Understand and Act to Address Health Disparities.

Michael R. Crawford
Assistant Vice President for Strategy and Innovation, Howard University Office of Health Affairs

Michael is a strategic advisor to the Senior Vice President of Health Affairs, and to the CEO of Howard University Hospital Corporation, where he collaborates with medical science, health, academic and board leadership to advance the university’s academic, health and innovation mission. He is also the host and executive producer of the 21st Century Health podcast.

Hear his perspectives on reducing disparities in: Innovating to Address Health Disparities.

These are just a few of the diverse speakers who’ll share their expertise at the Health Quality Forum. View the full list of speakers here.

Why Should You Attend the Forum?

With expert-led sessions, hands-on workshops and ample networking opportunities, the Health Quality Forum provides the tools and insights you need to optimize care delivery and drive measurable improvement.

You’ll have access to:

• Expert guidance on regulatory changes and best practices.
• Opportunities to network with industry leaders and peers.
• Real-world case studies on successful quality initiatives.
• Insights into emerging trends in care delivery and data analytics.
• Expert training and gap analysis tools for Virtual Care and Health Equity Accreditation.

Whether you’re responsible for clinical quality, accreditation or data-driven decision making, the forum provides a platform to exchange ideas and develop practical strategies for lasting impact.

Join Us in Baltimore

This is your opportunity to engage with health care leaders, gain strategic insights and implement real change in your organization. Seats are filling up fast, so register today!

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Learn how states and their partners are improving care for vulnerable and underserved communities, and focusing on health disparities in areas facing the greatest barriers to quality care. The forum will equip attendees with the tools they need to align real-world solutions for better health outcomes with their broader business goals.

Opening Keynote Speaker—Dr. Meena Seshamani

Our opening keynote will feature a Fireside Chat with Meena Seshamani, MD, PhD, Incoming Secretary of the Department of Health for Maryland, and NCQA President and CEO, Peggy O’Kane.

Dr. Seshamani is an accomplished leader with a deep understanding of health care policy and operations and a commitment to patient care. She was most recently deputy administrator for CMS, where she led the Medicare Drug Price Negotiation program and implemented initiatives to improve Medicare’s prescription drug coverage. She was also instrumental in transforming Medicare to provide more holistic care and enhanced support for individuals with disabilities.

Peggy and Dr. Seshamani will discuss the state of health care quality today, trends on the horizon and how Maryland will navigate the opportunities and challenges ahead.

Session Highlights

The Health Quality Forum is more than a conference—it’s a hands-on, solutions-driven experience designed to help you turn quality insights into practical strategies. Don’t miss these enlightening presentations.

Virtual Care: Patient Access and Choice

Featured speakers:

• Ann Mond Johnson, CEO, American Telemedicine Association
• Laurel Ghose, Director, Connected Care, VA Boston Healthcare System
• Eric Schneider, MD, Executive Vice President, NCQA

Going Beyond “Community Health Needs Assessment” to Understand and Act to Address Health Disparities

Featured speakers:

• Jacqueline Ortiz, VP of Health Equity and Cultural Competence, ChristianaCare
• Gina Lathan, CEO, LathanHarris, Inc.

 Current Efforts to Create Accessible Systems of Care for Populations with Disabilities

Featured speakers:

• Amena Keshawarz, Applied Research Scientist, NCQA
• Megan Morris, Associate Professor, New York University Langone Health
• Ross Owen, Director of Improvement and Integration, HealthPartners

Rural Health Divide: Leveraging Virtual Care to Tackle Rural Health Disparities

Featured speakers:

• Laura Hepp Kessel, Executive Director of Telehealth Services, SIU Medicine
• Rosalyn Perkins, Director of the High-Risk Pregnancy Program, University of Arkansas for Medical Sciences, Institute for Digital Health & Innovation

A Case Study in Data Usage: North Carolina’s Experience Using Data to Drive Outcomes

Featured speakers:

• Jessica Kuhn, Medicaid Quality and Population Health Systems Analyst, North Carolina Health Information Exchange Authority
• Larry Mull, Deputy Director, Program Evaluation, North Carolina Medicaid

Why You Should Attend

The Health Quality Forum is your opportunity to go beyond conversation and take action to improve health care quality and equity.

Get the most out of your experience with:

• Public-private collaborations to align quality measures and policies to create meaningful change.
• Targeted workshops and peer learning focused on closing care gaps and addressing health disparities.
• Exclusive training on NCQA’s Accreditation programs and access to NCQA subject matter experts.
• In-depth conversations in a positive, solution-focused atmosphere.

Join Us in Baltimore

Ready to be part of a forum that unites policy, quality and strategy to create meaningful change? Reserve your spot today!

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WellSpan is an integrated health system with more than 23,000 team members across 13 counties in central Pennsylvania and northern Maryland, delivering high-quality, safe, reliable and equitable care in inpatient and ambulatory settings. Pursuing NCQA Health Outcomes Accreditation was a natural progression for WellSpan—57 of its medical practices have earned Patient-Centered Medical Home Recognition, and its Population Health services have earned Case Management and Utilization Management Accreditation.

“We have a long history of serving the needs of our community and improving access to care for all people,” says Dr. Mike Seim, Senior Vice President and Chief Quality Officer at WellSpan. “Pursuing Health Outcomes Accreditation gave us an opportunity to further refine our processes and identify areas where we had opportunities or could make improvements toward equitable care.”

Getting Leadership Buy-In

Sustained, impactful health equity work requires strong leadership and a willingness to prioritize health equity as a way of doing business, with specific objectives and dedicated resources. Health Outcomes Accreditation was a vehicle for Dr. Seim and WellSpan’s CEO, Dr. Roxanna Gapstur, to drive organizational changes and communicate health equity-focused goals to every part of the organization.

Performing a Gap Analysis

Although WellSpan had a long history with health equity and quality improvement, a gap analysis identified key areas for improvement.

• Data Collection. WellSpan collected data on race, ethnicity and language, but not on sexual orientation and gender identity.
• Process Improvement. WellSpan had experience providing culturally and linguistically appropriate services, but wanted to make its health equity practices more structured and sustainable.
• Patient Experience. WellSpan collected data on patient experience, but hadn’t reviewed the data through a health equity lens.

“The gap analysis was enlightening and really helped shape our equity initiatives moving forward,” says Ann Kunkel, VP Community Health, Home Care and Hospice. “The Accreditation process created a framework for us to align our processes with established standards and best practices.”

Navigating the Survey Process

Organizing the information and managing the survey process is a significant undertaking that requires a team approach. Although WellSpan does not have a dedicated “health equity team,” it was able to leverage multidisciplinary collaboration across departments, such as Quality, Community Health and Engagement and Diversity, Equity and Inclusion. Each leader identified individuals from their team to join the project.

“We were able to harness the passion and dedication of our employees to prepare for the survey,” says Holly Wolfe, Senior Director of Quality. “The team’s strong analytic capabilities and prior experience working with CMS and state regulators were essential for our success.”

WellSpan established a Health Equity Steering Committee that reports to the Board of Directors. Dr. Seim provided executive oversight, and the team leaned heavily on the expertise of key departments—Community Health and Engagement, Language Services and Quality Management. The presence of an effective project manager helped organize meetings and ensure the right participants were engaged.

Improving Organizational Performance

Accreditation provided a framework for WellSpan to refine existing processes and accelerate change in the organization.

• Create Alignment. The Accreditation standards helped demonstrate how each part of WellSpan’s operations contributes to its goals of improving patients’ health, access to care and overall experience.
• Encourage a Proactive Approach. The Health Outcomes Accreditation empowered WellSpan to be proactive and intentional about identifying and selecting its focus areas—a capability it’s using to tune in to the unique needs of diverse populations.
• Improve Employee Engagement. The Accreditation allowed WellSpan to increase employee engagement by cultivating a culture of equity where staff view themselves as allies to their patients and to each other.

WellSpan’s Health Outcomes Accreditation has also been a springboard for public speaking engagements and recognition of its commitment to quality and equity, including winning the American Hospital Association’s Quest for Quality Prize in 2024.

Reducing Health Disparities

Pursuing Health Outcomes Accreditation propelled WellSpan’s efforts to reduce disparities in care and embed health equity goals in all aspects of care delivery—for example, its project focused on closing the disparity gap in breast cancer screening and colorectal cancer screening. By creating new variables for race, population of color and language, WellSpan was able to identify disparities, implement culturally and linguistically appropriate outreach and address patients’ social drivers of health.

These efforts led to positive improvements in health outcomes and projected life expectancy for people of color.

• Breast cancer screening rates for people of color improved by 6.31% from MY 2022 to MY 2023, preventing an estimated 15 breast cancer deaths and adding 215 years of life.
• Colon cancer screening rates improved by 8.73% for people of color from MY 2022 to MY 2023, preventing an estimated 360 colorectal cancer deaths and adding 4,053 years of life.

“One of the benefits of NCQA’s Health Outcomes Accreditation is our ability to measure progress objectively,” says Dr. Seim. “We have the data to identify disparities in health outcomes and track our progress in closing the gaps—and that leads to more equitable care for all patients.”

Learn More

• Visit our website to learn more about NCQA’s Health Outcomes Accreditation.
• Take an online course: Multi-Cultural Resources and Tools to Engage Members and Communities.

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