Dec. 2025 — Each year, the National Committee for Quality Assurance (NCQA) releases updates to the technical specifications for the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures. As an NCQA-accredited health insurance company, Wellmark Blue Cross and Blue Shield shares relevant information with providers on HEDIS requirements to help support provider delivery of the best care possible.

These updates reflect evolving clinical guidelines, coding standards and best practices aimed at improving the accuracy and relevance of quality measurement.

For detailed information on individual measures, including coding guidance and documentation tips please refer to the Quality measure tip sheets page, for resources to support accurate and efficient care. Note: not every measure has a unique tip sheet. Check back regularly as materials are added throughout the year.

Changes to measures beginning Jan. 1, 2026

Statin Therapy for Patients with Cardiovascular Disease (SPC-E)

• Initial population includes any patient between the ages of 21 and 75 identified as having clinical atherosclerotic cardiovascular disease (ASCVD).

Adult Immunization Status (AIS-E)

• COVID-19 vaccine added for patients 65 and older. No changes to other vaccines.

Follow-Up After High Intensity Care for Substance Use Disorder (FUI)

• Peer services counts as an appropriate follow-up visit to a high intensity care for a substance use disorder.

New measures in 2026

Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E)

• AAF-E looks at the percentage of patients between the ages of 5 and 64 with an urgent care visit, acute inpatient discharge, observation stay discharge or ED visit with a diagnosis of asthma which had a corresponding outpatient follow up visit with a diagnosis of asthma within 30 days.

Blood Pressure Control for Patients with Diabetes (BPD-E)

• BPD-E will be reported using electronic data sources only such as claims and electronic health record data feeds making accurate coding even more important. This measure will eventually replace the Controlling Blood Pressure (CBP) measure.

Tobacco Use Screening and Cessation Intervention (TSC-E)

• TSC-E reviews the percentage of patients 12 years of age and older who were screened for commercial tobacco product use at least once during the measurement period, and who received tobacco cessation intervention if identified as a tobacco user.