TL;DR
- NCQA is building a new ECDS Transitions of Care measure, with the earliest implementation in MY 2028 and hybrid TRC retiring in MY 2029.
- Hybrid TRC currently sits in the Medicare Star Ratings, so NCQA is coordinating the change with CMS; the first fully digital Star-rated measure will run as a live proof of concept.
- Some TRC components cannot yet be expressed in standard code sets, which means the specification itself is still being solved, not just the data plumbing.
- Plans that wait for the final specification will build the data layer too late, because ECDS reporting needs continuous structured data, not a spring abstraction sprint.
The measure NCQA chose to test first is the one that hurts most
When NCQA wants to signal how serious it is about retiring hybrid HEDIS, the telling fact is not the announcement’s date. It is the measure it selected to lead the transition. On August 26, 2026, NCQA said it would build a new Transitions of Care (TRC) measure on the Electronic Clinical Data Systems (ECDS) methodology, and coordinating with CMS, because the current hybrid TRC measure is part of the Medicare Star Ratings (NCQA, 2026). Of all the hybrid measures left, this one carries the most operational weight: it touches three Star Ratings-adjacent numerators, discharge visit rates, patient engagement rates, and a medication reconciliation rate, each judged against different look-back windows.
The existing hybrid TRC workflow runs the way hybrid HEDIS has run for two decades. A plan pulls a sample of eligible members from administrative claims, requests medical records from providers, and pays abstractors to confirm discharge follow-up visits and medication reconciliation by hand (Johns Hopkins Health Plans, 2025). The measure’s hybrid numerator requires documentation of a discharge visit within 7, 14, or 30 days, patient engagement with telehealth or at-home visits counting within the 30-day window, and medication reconciliation on the date of discharge through 30 days (31 total days) (Johns Hopkins Health Plans, 2025). Each component means a separate chart chase, a different evidence standard, and a deadline.
The ECDS version replaces that machinery with structured data flowing from electronic clinical data systems, which is precisely where most plans are thinnest. The organization cannot abstract its way to an ECDS rate. Either the discharge visit, the reconciliation, and the follow-up are already recorded in structured form, or they do not exist for the measure at all.
The specification is not finished, and that should change your timeline
A reader skimming the announcement could conclude there is time, because the earliest implementation lands in MY 2028 and hybrid retirement follows in MY 2029 (NCQA, 2026). The harder truth sits one paragraph earlier in NCQA’s own statement. Fern McCree, Director of Digital Quality Informatics at NCQA, said the current hybrid TRC measure “has multiple components, some of which may not directly translate to electronic clinical data,” and that the development process has to solve for that while keeping the measure useful and meaningful (NCQA, 2026).
That admission splits the work into two tracks with different clocks. The specification work runs on NCQA’s clock: a proposed measure will circulate for public comment, CMS gets consulted, and the timeline stretches across several measure years (NCQA, 2026). The data work runs on the plan’s clock: interoperability standards such as HL7 FHIR and USCDI can already carry many TRC components, but the plan’s record of medication reconciliation depends on what a hospital’s discharge workflow writes back to the EHR, and that recording behavior changes slowly, hospital by hospital (NCQA, 2026).
The abstractors who file charts today do something the EHR record does not: they read a free-text note, reconcile the discharge medications against a pharmacy fill, and judge that this constitutes reconciliation. ECDS reporting asks the care process to produce that judgment as data. Where hospitals code reconciliation events into structured fields, plans will be fine. Where the evidence lives in narrative notes, the measure will go dark unless someone intervenes, which is a care-delivery outreach problem, not a reporting one.
Every hybrid measure left is watching this one
The strategic reading is simpler than the plumbing. NCQA retired hybrid reporting for Lead Screening and both Statin measures in MY 2026, moved blood pressure control to voluntary ECDS reporting, and has now aimed a full ECDS rebuild at the highest-profile hybrid measure still inside Star Ratings (NCQA, 2025). The pattern is not that TRC is special. The pattern is that each retirement teaches the industry what the next one will demand.
Three lessons transfer. First, ECDS moves the burden upstream: instead of a seasonal abstraction sprint, structured production data must exist continuously, which rewards organizations running live chart review rather than an annual HEDIS blitz (our dQM roadmap post covers the timeline). Second, coordination with CMS on a Star-rated measure is the highest-cost migration the industry has attempted, so every stakeholder watching it will learn the real friction points before their own measure is converted. Third, the public-comment window before the MY 2028 specification is the one chance plans have to shape the measure toward what their data can actually support; submitting nothing means accepting whatever the specification turns out to be (NCQA, 2026).
For a health plan quality leader, the concrete motion is unglamorous. Inventory your structured clinical data as it exists today against the three TRC numerators. Identify the hospitals whose discharge records make structured reconciliation possible and the ones where it lives in prose. Start closing that gap now, because the dry run starts before the specification is final. The organizations that run their HEDIS season with AI abstraction and a continuous data layer are, in effect, already rehearsing the 2028 show (see what AI abstraction changes about HEDIS season).
Sources
- NCQA, “The HEDIS Transitions of Care Measure Is Moving to ECDS Reporting: How You Can Start Preparing Now” (August 26, 2026): the ECDS TRC measure announcement, MY 2028 earliest implementation, MY 2029 hybrid retirement, the Star Ratings coordination with CMS, and the glossary-gap admission by Fern McCree. blog.ncqa.org
- NCQA, “HEDIS MY 2026: What’s New, What’s Changed, What’s Retired” (August 2025): the retirement of hybrid methods for Lead Screening and Statin measures, and the voluntary ECDS path for Blood Pressure for Diabetes. www.ncqa.org
- Johns Hopkins Medicine, Johns Hopkins Health Plans, “Transitions of Care Patient” and related HEDIS measure pages (2025): the hybrid TRC numerator structure, the 7-, 14-, and 30-day discharge visit windows, the 30-day patient-engagement window, and medication reconciliation through 31 days. www.hopkinsmedicine.org