It takes considerable effort for healthcare payers to distinguish themselves from the noise. Employers and consumers have a smorgasbord of healthcare plan options available to them. Without clear standardized metrics to compare the level of quality care, healthcare purchasers might overlook your offerings in favor of a more arbitrary deciding factor.
That’s why HEDIS (Healthcare Effectiveness Data and Information Set) measures have been adopted by the majority of healthcare insurers, shaping the plans of more than 227 million people. Having everyone speaking the same language rewards merit over false status.
However, we know that remaining at the forefront of consideration takes proactive changes. Health payers need to be constantly improving HEDIS measures or risk lagging in their HEDIS ranking and threaten their chances at NCQA accreditation.
The NCQA proposed changes for 2025 are less drastic than in some years (changes during the COVID years were fairly substantial), but they still contribute to enhancing standard care quality improvements. Here are the HEDIS measurement year (MY) 2025 changes as well as the three changes you can make to evolve your approach to quality measures can help to better improve healthcare member engagement.
Changes to HEDIS MY 2025
Let’s start by looking at the new developments. For the upcoming HEDIS measurement season, there will be:
- Three new measures
- Four retired measures
- Multiple measures tweaks
- Continued shifts to the Electronic Clinical Data Systems (ECDS)
As always, HEDIS measures are designed to address the healthcare challenges and shortcomings of the moment, and MY 2025 is no different. The new measures are designed to address timely documentation after mammograms, follow-ups after abnormal breast cancer assessments, and blood pressure control for patients with hypertension. As breast cancer rates rise among women under 50 and one-third of American continue to struggle with hypertension, these changes have the potential to make a major difference.
As far as those measures being retired, the goal appears to be recalibrating HEDIS to encourage precision care and prioritize non-pharmacological components of care first. For example, the Pain Assessment indicator will be retired since it fails to differentiate between acute and chronic pain. Additionally, the Antidepressant Medication Management measure is retired because it overlooks non-pharmaceutical solutions and the steps clinicians might take to avoid pharmacological treatments, leaving it as a last resort.
Beyond these meatier changes, there are some nuanced tweaks to seven existing measures as well as a shift to ECDS reporting for Childhood Immunization Status, Immunizations for Adolescents, and Cervical Cancer Screenings.
Be sure that your organization and any nurses, coders, and administrative staff know these HEDIS changes in detail. Otherwise, your score might drop or efforts might be wasted needlessly.
Using HEDIS Measures to Optimize Engagement
Even with the right HEDIS measures on your radar, you need to cultivate the proper strategy to engage members to satisfy new and existing standards. Here are the strategies we’ve seen help payors to elevate their score.
1.) Effectively Use Outreach Programs to Approach Members
Regularly fulfilling HEDIS measures requires eligible members to be proactive about their own healthcare. Hoping that enough members schedule appointments, procedures, tests, medication management, or on their own is a bold leap of faith. Since various measures have different anchor dates, healthcare payers need to pursue outreach programs that find the perfect members by strategically using disparate data sources to find out who has the soonest deadlines.
Take colorectal cancer screenings. No one wants to go through the process of getting examined, but the benefit is great. Screening for colorectal cancer every one to two years for people 50 and older reduces the number of fatalities by 15% to 33%. Nonetheless, members need a friendly reminder of the benefits inherent in such a test.
Outreach programs, especially those with over-the-phone or video outreach teams, are better at encouraging members to take care of themselves, improving HEDIS measures simultaneously. In fact, we see that member engagement increases by four times when outreach is targeted, especially when multiple measures are pursued at once.
In fact, HEDIS outreach needs people who are savvy with telemedicine platforms, encouraging members to satisfy multiple virtual measures at once.
2.) Target Members That Satisfy Multiple HEDIS Measures
Knocking out HEDIS measures one at a time is not cost-effective. The time your outreach team spends on each call costs money and, if the right data is employed, that time can be used in a cost-effective way to target members who can improve multiple HEDIS measures with one appointment. And using data analytics and even artificial intelligence to identify the appointments, vaccines, prescription medications, and/or screenings members.
Consider the above example. Certain members who would benefit from colorectal screening more than likely also need proactive services that satisfy other HEDIS measures. Visits to primary care doctors for a wellness exam, to control hypertension, or to manage diabetes are legitimate concerns for people in the 50 and above age bracket. The challenge becomes predicting which patients will have overlapping conditions based upon data that ranges across their age, gender, previous screenings, medical history, and other variables.
Manual reviews would take an expensive amount of time. Analytics tools and artificial intelligence platforms can automate the review process, parse through millions of digital files, and isolate patterns and correlations that human analysts might miss. From there, your outreach initiatives can be prioritized based on those people who satisfy multiple HEDIS measures with one encounter or visit.
3.) Facilitate the Appointment
Automated text and email messaging have been a major leap forward in member engagement, helping to increase some wellness appointment scheduling. However, leaving members on their own to schedule their next check-up or follow-up appointment will still result in some members failing to take action.
That is why improving HEDIS measures really requires a personal touch that facilitates members through scheduling and attendance.
For example, our quality outreach programs do not leave appointment scheduling to chance. When we call a member who satisfies several HEDIS measures, we make the entire process simple and straightforward. We educate members on the proactive healthcare services that benefit them and help schedule the appointment along with their providers, offering them a guide through that awkward first call.
We also reach out to the provider office to alert them to the possible HEDIS benchmarks that can be captured at the time of the appointment. This often results in pay-for-performance dollars or incentive for the provider.
By creating a connection with the members and providers, we facilitate appointments more easily and increase the probability that members will work with us to take care of their own health in the future, thus improving HEDIS measures in a painless way.
Improving HEDIS Measures Requires the Right People, Processes, and Technology
All the above strategies rely upon a well-trained team of quality outreach professionals who relate to members’ concerns and help them realize that proactive appointments are the solution to improving their health. Moreover, it helps to have a scalable workforce that can pivot at a moment’s notice.
Starting a division like that from scratch takes time, money, and the right tools to target services that fulfill several HEDIS measures. Thankfully, options exist that accelerate the time it takes for your quality outreach program to bear results.
Our 20 years of healthcare experience helps us to unlock the potential of improving HEDIS measures by providing the tools, the training, and the personnel to make a quality outreach initiative smooth and strategic. Our experience attracting and placing top professionals will have you prepared for HEDIS MY 2025 and any in the future.
Want to learn how to improve HEDIS measures? Here’s how we helped one payor achieve their HEDIS goals.