The HEDIS Kidney Health Evaluation (KED) Measure: A Complete Guide for Health Plans

Kidney disease is one of the few conditions where the screening tools have existed for decades, the tests are inexpensive, and the disease still goes undiagnosed in the vast majority of people who have it. The Kidney Health Evaluation for Patients with Diabetes (KED) measure exists because of that gap, and it's newly weighted in Star Ratings, which means it deserves more attention from quality teams than it's historically gotten. This guide covers what KED requires, why completion lags even when members show up for care, and how at-home testing addresses the specific reason this measure is hard to close.

What Is HEDIS, and What Does the KED Measure Require?

HEDIS, the Healthcare Effectiveness Data and Information Set, is the quality measurement framework the National Committee for Quality Assurance (NCQA) uses to evaluate health plans. More than 90% of U.S. health plans report HEDIS data, and for Medicare Advantage plans, HEDIS performance feeds directly into Star Ratings and the quality bonus payments tied to them.

NCQA introduced KED in HEDIS Measurement Year 2020, developed with the National Kidney Foundation specifically because so few people with diabetes were getting a complete kidney evaluation. The measure evaluates the percentage of members ages 18 to 85 with type 1 or type 2 diabetes who completed both of two required tests within the measurement year: an eGFR (estimated glomerular filtration rate) blood test and a uACR (urine albumin-creatinine ratio) test. A member only counts toward the measure once both results are on file — one test alone doesn't close the gap.

KED is also new to 2026 Medicare Advantage Star Ratings as a process measure, starting at a weight of 1. That's lower than the weight-3 clinical measures that still drive most of a plan's Star score, but it's a signal that CMS and NCQA expect kidney screening to matter more to Star performance over time, not less.

Diabetes and Kidney Disease, by the Numbers

More than 37 million American adults have chronic kidney disease, and roughly 9 in 10 don't know it — kidney disease is largely asymptomatic until it's advanced. Diabetes is the single biggest driver: it accounted for 46% of new kidney failure cases between 2019 and 2021, with hypertension responsible for another 29%. Roughly 1 in 3 adults with diabetes will develop kidney disease, and kidney disease itself is now the eighth-leading cause of death in the U.S. — more than breast and prostate cancer combined.

None of this is a testing-availability problem. eGFR and uACR are inexpensive, well-established tests, and fewer than half of people with diabetes get both in a given year. The barrier isn't sciencet's completion.

The Two Tests That Count Toward KED

• eGFR (estimated glomerular filtration rate). A blood test that estimates how well the kidneys filter waste. It's often ordered as part of a routine metabolic panel members already get for diabetes management, which is why eGFR completion tends to run high.
• uACR (urine albumin-creatinine ratio). A urine test that detects protein leaking into urine — an early sign of kidney damage that can show up before eGFR declines. The ratio itself is calculated from two components: a quantitative urine albumin test and a urine creatinine test, and per NCQA/HEDIS specifications, the two must be performed within four or fewer calendar days of each other to count as a valid uACR. NCQA also requires a quantitative result — semi-quantitative or dipstick results stopped counting toward the measure starting Measurement Year 2024. So creatinine isn't a separate, optional add-on to the kidney evaluation — it's baked into what makes a uACR result valid at all.

Why the Two-Test Requirement Is the Real Problem

A study of more than 500,000 patients with type 2 diabetes across 24 U.S. health systems found eGFR completion near 90%, while uACR sat at just 53%. That gap isn't random — it's structural. eGFR rides along on bloodwork providers are already ordering. uACR requires its own order, its own urine sample, and often a separate collection members don't complete in the same visit where their blood was drawn. A member can walk out of an annual wellness visit having "done" their kidney screening and still be an open KED gap, because nobody asked for the urine sample.

That's a hard pattern to fix with reminder letters alone. A member who already believes they were tested has no reason to respond to outreach asking them to get tested again.

At-Home Testing: Closing Both Halves of the Measure at Once

Because uACR and eGFR are both simple specimen collections — a urine sample and a blood draw — the KED gap looks a lot like the completion problem, not an access problem, that other HEDIS measures face. Ash ships at-home kits that cover the biomarkers KED requires, including quantitative uACR, eGFR, and serum creatinine, directly to the member under the plan's own brand. Because both specimens go out together in one kit, a member isn't relying on a provider to remember the second order — the whole evaluation ships as one request instead of two.

Outreach still matters once the kit is in hand. Members who receive Ash's omni-channel outreach — email, SMS, and AI-powered calls working together — complete testing 2.4 times more often than members who get a single reminder channel,¹ which for KED specifically means fewer members stalling out with an eGFR on file and no uACR to go with it.

Building a KED Program That Closes Both Tests, Not Just One

KED is unusual among HEDIS measures because the science, the cost, and the access are all solved problems — what's left is making sure both tests happen for the same member in the same year. Plans that treat KED as a single request instead of two separate orders will see completion rates move faster than plans running eGFR and uACR as independent workflows.

If your plan is building or refining a kidney health screening program, Ash can help. We support KED with white-labeled at-home kits covering eGFR, uACR, and creatinine, multi-channel member engagement, and dedicated clinical oversight — built to close both halves of the gap before the measurement year ends.

For more on how at-home testing supports kidney-related HEDIS measures broadly, see Ash's guide to closing CKD screening gaps.

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