For decades, HEDIS® reporting has relied on a fragmented and manual process. NCQA would publish narrative specifications for each measure, and vendors have historically interpreted and implemented those guidelines on their own, leading to proprietary systems, redundant coding efforts, and costly certification cycles to validate accuracy.
But all that is changing.
NCQA’s Push Toward Digital Quality Measurement
To meet the growing demands of value-based care and enable real-time, data-driven insights, NCQA has launched its Digital Content Services (DCS) program, marking the transition to digital HEDIS. Rather than interpreting written guidance, vendors and payers can now directly access and utilize official HEDIS measures as machine-readable artifacts in FHIR® and CQL.
Importantly, this shift, though not yet mandated, is imminent. NCQA has announced a target of 2030 to fully retire traditional HEDIS, ending certification for proprietary interpretations and standardizing the path forward with digital-first content.
What This Means for Payers
Payers relying on traditional, manual HEDIS processes will face:
- Rising administrative costs
- Delayed quality insights
- Inability to meet real‑time reporting demands, and limited scalability
- Increased risk of provider and member dissatisfaction
- Increased competition for CMS Star Rating’s bonus payments
Moving to digital HEDIS is a strategic modernization effort, beyond the check-the-box compliance. Early adopters gain agility, accuracy, interoperability, and market leadership in tomorrow’s data-driven healthcare landscape.
2030 is Far Away: But 2026 is Critical
While 2030 is the NCQA’s target for full digital HEDIS adoption, the next two years set the foundation:
What U.S. Payers Must Do in 2025/2026
How Smile dQM is Leading the Shift to Digital HEDIS
Smile dQM for HEDIS solution is built for this shift. As an NCQA Early Adopter and a leading member of DQIC (Digital Quality Implementers Community), Smile directly integrates digital measures from the DCS (NCQA’s Digital Content Services) program, eliminating custom coding, reducing manual work, and enabling automated, near-real-time quality evaluation for millions of members.
Our FHIR-native platform provides end-to-end support, from ingesting disparate data to executing certified logic and delivering patient-level insights, all with the speed, scale, and standards alignment payers need.
The future of HEDIS is digital. Smile is ready, are you?
Don’t have a quality measures roadmap for HEDIS?We can help you build your step by step transition plan to Digitized HEDIS.