Lessons From the Field: Where Health Plans Really Are on Digital HEDIS

Over the past few months, I have sat in on more than a dozen conversations with health plan quality teams about digital quality measures (dQMs). Different plans, different markets, different sizes. One question surfaced in almost every room, “am I behind?” 

The short answer is: almost certainly not. 

Here’s what I am seeing in the field and what I think it means for your own digital HEDIS® transition. 

Most plans are at the starting line 

The loudest voices in this market would have you believe everyone else is already deep into testing  – they are not.  

In the conversations I’ve been part of, the majority of plans are right at the beginning. They’ve stood up a working group (or are about to), and they’re starting to ask what data they have, where it lives, and what shape it’s in.  A few health plans are further along, with some clinical data already moving through Fast Healthcare Interoperability Resources (FHIR®) and a rough sense of where the rest will come from. And a small handful of plans are genuinely at the front of the pack, ready to run comparative testing the moment they can. 

Wherever you land, you are in good company. One quality leader I spoke with recently asked, “is any of this even required yet?” It’s a reasonable question to be asking in 2026, so let’s breakdown the timeline of when dQMs are coming.  

There is no prize for being first 

The National Committee for Quality Assurance (NCQA) has set a goal of moving HEDIS reporting to a fully digital format by 2030, and has been clear that the pace depends on market readiness. 

That’s four years out. So when a vendor tells you that you are already behind, ask who benefits from the urgency. Four years out is too early to panic, but it is not too early to plan. For most plans, the responsible move is to start budgeting for testing two to three years ahead. Sprinting to the front of the line buys you nothing. Leaving it to the final year does your plan no favors. Aim for the middle, and give yourself room to get it right. 

Additionally, NCQA has eased up on the timeline. Last fall, the expectation was a full season of parallel testing with your traditional HEDIS and digital measures run side by side. Earlier this year, NCQA softened that. The expectation is now voluntary comparative testing, something you can choose to do any time between now and 2029. Comparing your digital numbers against your traditional ones is still smart and worth doing, but now the timing belongs to you.  

This is a marathon and should have marathon pacing. Pull your team together, talk to the HEDIS vendor who has supported you for years, look hard at your data sources, work out whether you have the FHIR resources in house or whether you need a hand. Don’t panic.  

Candidly, some of the newer, dQM-only vendors push the hair-on-fire message because they need proof points and reference customers; health plans transitioning early serves them. Be aware that if you bring on a dQM-only vendor alongside your existing HEDIS vendor you will have an additional relationship to manage, and it’s possible you’ll have to bear the cost of a multi-year parallel run.  

The real worry I keep hearing is about rates 

Here is the concern that comes up more than any other, and it is the one that keeps quality leaders up at night: what happens to my rates when this is done? 

NCQA plans to phase out the hybrid collection method by measurement year 2029. For plans that have benefited from the impact of hybrid chart review, moving to a fully digital view can expose gaps that sampling used to smooth over. The plans most exposed are the ones without the resources to acquire additional clinical data, whether that means standing up new feeds or paying provider groups for records. 

One quality director put it bluntly, “without access to richer clinical data, rates will suffer once hybrid goes away.” This is a real concern, and pretending otherwise helps no one. 

This is where the right partner earns their keep. Closing that clinical data gap, acquiring electronic records, getting more of your true performance to show up in the numbers, is all solvable. But it is work you should be scoping now, while you still have time, rather than in 2029 when you do not. 

The dQM questions worth bringing to your vendor 

A pattern I’ve noticed is the plans having the most productive conversations are the ones asking sharp, specific questions. If you are not sure where to start, here are the ones I would put on the table: 

• Are you building a separate application for dQM, or enabling your existing technology to do both? If a vendor wants you to adopt a whole new system, ask why. 
• What happens to my processing times and service levels in the digital world?  
• Can you convert my existing data feeds into the FHIR format, or is that on me? 
• What does the digital output actually look like, and how does it compare to the detailed files my team relies on today? 
• How will audits and Clinical Quality Language (CQL) versioning work, and how do we reconcile differences between calculations? 

You do not need every answer this quarter. You do need a vendor who will sit down and work through these with you, on your timeline. If the people who have supported your quality program for years are not proactively raising this with you, that tells you something. 

Where to start 

If you take one thing from the field, let it be this: starting now does not mean rushing now. Starting means getting organized. 

A reasonable first 90 days looks like this: 

• Convene the internal group that will own the work.  
• Inventory your data, what you have, where it lives, what format it is in.  
• Assess your FHIR readiness honestly.  
• Decide, source by source, what you can handle yourself and where you will want help.  
• Then talk timeline with your vendor, and let it be your timeline, shaped around your rates, your resources, and your quality program, not someone else’s campaign calendar. 

For the plans we work with, this is an evolution of the quality program you already run, not a new system to stand up. Our existing engine is already certified across all 77 of NCQA’s digital HEDIS measures, so the move to digital happens inside the operation your team already knows. We built a readiness assessment to make the planning part easier, and we are walking customers through it right now as part of our ongoing dQM conversations. The point is to make a big transition feel manageable. Your team carries the larger share of this lift, the least we can do is help you carry it. 

This will not be the last you hear from us on digital HEDIS. We are gathering the questions we hear most in the field and turning them into a short Ask the Expert series, so you can hear directly from people who have lived through every HEDIS transition before this one. Bring us your hard questions. We would rather earn your confidence than borrow your fear. 

Talk to the Inovalon quality team. 

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