By Karen Manning, RN, BSN, MBA, Director, Business Solutions, Abacus Insights

After years of adding measures, programs, and reporting requirements, the quality community arrived at the National Committee for Quality Assurance (NCQA) Health Innovation Summit, NCQA 2026, held October 4–7 in Atlanta, with a shared question: how do we make all of this simpler and more useful?

Digital quality measurement, AI, interoperability, health equity, and value-based care were recurring topics, and most returned to the same goal: connecting measurement more directly to meaningful outcomes.

Health plans have spent years navigating increasingly complex quality programs across Medicare, Medicaid, Commercial, Marketplace, and state-specific requirements. As measure sets and reporting requirements have expanded, so has the administrative burden on plans and providers. Speakers repeatedly called for fewer, more meaningful measures that can be applied consistently across lines of business and used to drive real-world improvement.

Here are five themes from NCQA 2026 and what they mean for health plan quality priorities.

1. Simplification Is Becoming a Priority

One of the strongest messages from the conference was that the industry cannot keep layering new measures onto an already complex quality ecosystem.

Sessions emphasized the value of “parsimonious” measure sets (smaller, higher-impact sets of measures), shared clinical definitions, aligned denominators, and less fragmented reporting across programs. Speakers also called for focusing less on process (activities completed) and more on outcomes achieved.

This shift is not about reducing accountability. It is about greater consistency, less administrative burden, and more room to focus on improving care instead of managing reporting complexity.

For health plans managing multiple lines of business, the opportunity is significant: a more streamlined measurement landscape can improve operational efficiency and help align quality improvement efforts across diverse member populations.

What it means for plans: map where measure definitions and reporting differ across your lines of business, then consolidate improvement work around the measures that overlap most.

2. Trusted Clinical Data Is the Foundation 

If one capability repeatedly emerged as essential to the future of quality, it was trusted clinical data.

Many organizations have already invested in acquiring data from electronic medical records, health information exchanges, laboratories, supplemental clinical data sources, and community-based partners. With more clinical data available, the focus is shifting from data acquisition to data trust: whether it is complete, accurate, standardized, traceable, and ready to use.

Health plans increasingly need a trusted, longitudinal clinical data foundation that supports digital quality measurement, analytics, care management, risk adjustment, health equity initiatives, and provider collaboration. Confidence in the underlying data is a prerequisite for these programs to scale effectively.

What it means for plans: audit the clinical data you already receive for completeness, provenance, and member match rates before investing in new sources.

3. Quality Is Moving Toward Continuous Improvement 

Historically, quality management has often relied on measuring performance after the fact. Across multiple sessions, speakers described a future where quality measurement is embedded directly into operational workflows and used to improve outcomes in near real time.

That includes prospective care gap identification, insights delivered within provider workflows, and actionable clinical interventions. This approach supports year-round care gap closure.

The industry is shifting from asking, “How did we perform last year?” to asking, “How can we improve outcomes today?” Timely information lets teams see where improvement is needed and intervene while the outcome can still change.

The goal is not simply to identify quality gaps. The goal is to close them. The insight has to reach the appropriate person, fit into an existing workflow, and lead to an intervention.

What it means for plans: measure how long it takes a care gap insight to reach the provider or care manager who can close it, and work to shorten that window.

4. Digital Quality Is Becoming Enterprise Infrastructure 

Digital quality measurement, including the move to digital HEDIS® Healthcare Effectiveness Data and Information Set), remains an industry priority, but the discussion has matured. Rather than viewing it as a compliance initiative, organizations are increasingly treating it as enterprise infrastructure that supports multiple strategic objectives.

FHIR, CQL, interoperability, supplemental data integration, and reusable quality assets were consistently discussed as foundational capabilities that can serve value-based care, analytics, population health, and care management as well as measurement.

Several sessions highlighted the transition from fragmented reporting environments to shared quality platforms built around common clinical data definitions, reusable digital assets, and interoperable architectures.

For health plans, this represents a critical mindset shift. Digital quality is no longer a standalone reporting project. It is becoming a core component of enterprise data and quality strategy.

What it means for plans: make digital quality part of your health plan data strategy so the definitions and integrations built for measurement can be reused by analytics, care management, and value-based care teams.

5. Action Is Becoming the Real Test of Quality Data 

The most practical discussions at the conference centered on converting quality insights into measurable action.

Sessions focused on embedding analytics into provider workflows, connecting quality teams with care management operations, improving provider engagement, coordinating payer-provider partnerships, and prioritizing interventions that drive measurable outcomes.

The emphasis was not on creating more dashboards. It was on delivering trusted insights to the right people at the right time to influence decisions and improve care. That depends on collaboration as much as technology. Quality, care management, and provider relations teams need shared priorities and clear ownership of each intervention.

Whether addressing hypertension, behavioral health, chronic disease management, social needs, or preventive care, successful organizations are increasingly focused on operationalizing quality rather than reporting on it.

What it means for plans: assign a clear owner and next step to every priority insight, and track whether the intervention happened.

What NCQA 2026 Means for Health Plan Quality

These five themes are closely connected. Operationalizing digital quality depends on a strong clinical data foundation. Acting on quality insights requires information that can move across systems and teams. Greater alignment also depends on common definitions and infrastructure capable of supporting multiple programs.

The one overarching takeaway from NCQA 2026 was this: the future of quality is not about measuring more. It is about measuring what matters. For health plans, that means simplifying measurement, aligning quality priorities across lines of business, building trusted clinical data foundations, and leveraging digital capabilities to turn quality insights into action.

A trusted, reusable data foundation can free teams to spend less time assembling and reconciling information and more time applying it across quality, care management, analytics, health equity, and provider collaboration.

The industry’s focus is shifting from retrospective reporting to continuous improvement. From fragmented measures to aligned outcomes. From data collection to data trust. And from quality reporting to quality transformation.

The organizations that embrace that shift will be best positioned to improve outcomes, reduce administrative burden, and thrive in the next generation of healthcare quality measurement. At Abacus Insights, that is the work we do with health plans every day: turning clinical data from many sources into a trusted, reusable foundation for quality and beyond.

How ready is your clinical data for digital quality? Request a data readiness assessment from Abacus Insights and get a clear view of where your data is complete, trusted, and usable across programs.

Frequently Asked Questions

What Is Digital Quality Measurement? 

Digital quality measurement uses standardized digital data and technology to calculate and exchange quality measures. NCQA plans to make HEDIS reporting fully digital by measurement year (MY) 2030 and to phase out the hybrid reporting method by MY 2029. 

Why Is Trusted Clinical Data Important for Health Plans? 

Standardizing, validating, matching, and tracing clinical data from EMRs, HIEs, laboratories, and other sources creates a reliable foundation for quality measurement and other health plan programs.

How Can Health Plans Simplify Quality Measurement? 

Aligning around meaningful measures, common clinical definitions, and consistent approaches across programs reduces reporting complexity and frees plans and providers to focus on improving outcomes.

How Does Interoperability Support Quality Improvement? 

Interoperability makes clinical information available across systems and workflows, so it can support quality measurement, care management, analytics, and provider collaboration.

What Is FHIR and Why Does It Matter for Health Plans? 

FHIR (Fast Healthcare Interoperability Resources) is an HL7 standard for exchanging healthcare data electronically. NCQA’s digital quality measures are built on it, which makes clinical data easier to share and reuse across quality, care management, and analytics programs.