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 235 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 threatening their chances at NCQA accreditation.
NCQA proposed changes for 2027 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 MY 2027 changes, along with four changes that turn HEDIS performance improvement into actions that actually improve healthcare member engagement.
Changes to HEDIS MY 2027
Let’s start by looking at new developments. For the upcoming HEDIS measurement season, there will be:
- Six new measures
- Three updated existing measures.
- One measure transitioned to Electronic Clinical Data Systems (ECDS) reporting
- ECDS-reported measures reorganized by clinical domain.
- Minor adjustments across multiple measures.
As always, HEDIS measures are designed to address the healthcare challenges and shortcomings of the moment, and MY 2027 is no different. The new measures are designed to:
- Detect colorectal cancer early
- Reduce the risk of congenital syphilis in newborns
- Support caregivers to work with clinicians to achieve meaningful goals
- Monitor glucose to help diabetes patients spot hypoglycemic and hyperglycemic events
The emerging public health priorities these HEDIS measures are designed to adjust can’t be understated. Look at the figures:
- One in five cases of colorectal cancer now occur in people 55 or younger
- In 2024, syphilis in newborns was up 700% compared to 2015
- 1 million Americans are diagnosed with diabetes
By instating these new HEDIS measures, the NCQA is incentivizing health plans to close care gaps and invest in the kind of preventive services that improve long-term outcomes.
As far as updates to existing HEDIS performance measures, the goal is to increase pharmacotherapy for chronic obstructive pulmonary disease (COPD), update age ranges for adult immunization, and track ER usage for people from 18 to 64 on Medicaid.
Beyond these meatier changes, there are some nuanced tweaks to existing measures as well as a shift to ECDS reporting for the Glycemic Status Assessment for Patients With Diabetes (GSD-E) measure.
Be sure that your organization and any nurses, coders, and administrative staff know these HEDIS changes in detail. Their contributions affect HEDIS measure performance at scoring time, and your score might drop or efforts might be wasted if they’re not fully informed.
Using HEDIS to Optimize Member Engagement
Even with the right MY 2027 measures on your radar, hitting them comes down to a single question: can your data prove the care happened? As HEDIS shifts to digital reporting, that becomes a data problem first. Here are four changes that get your data ready to perform.
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, or medication management on their own is a bold leap of faith. Since various measures carry different anchor dates, you need outreach programs that pinpoint the right members and reach them before their deadlines pass. HEDIS outreach automation can flag who is due for an appointment, and trained people are what actually move a member to act.
Take the new MY 2027 colorectal cancer screening measure, a clear opportunity for HEDIS cancer screening improvement. No one looks forward to the exam, and the benefit is significant. Screening adults starting at age 45 lowers colorectal cancer deaths considerably, lowering the risk of death by 50%. Members still need a friendly, human reminder of why it matters, and a real conversation, along with automation and AI engagement, makes a difference.
That level of engagement calls for people who work fluently across phone, text, and video, and who can guide members through newer, more sensitive measures. The new caregiver support measure, for instance, asks outreach staff to help caregivers work with clinicians toward meaningful goals, which is inherently a human conversation.
2.) Target Members That Satisfy Multiple HEDIS Measures
The smartest HEDIS strategies target members whose profiles close several gaps at once, making outreach more cost effective. Every minute your outreach team spends on a call costs money. Engagement teams with the right data can spend their time more effectively on members who can close several HEDIS gaps in care with a single appointment. AI and analytics identify which members need which appointments, vaccines, prescriptions, and screenings, then group those scattered HEDIS interventions into one efficient touchpoint.
Consider the above example. Members who qualify for colorectal screening often need other proactive services that satisfy additional MY 2027 measures. A member in the 50 and above bracket may also need diabetes glucose monitoring, hypertension control, and an updated adult immunization inside the same window. Reducing congenital syphilis in newborns takes coordinated prenatal outreach across several touchpoints. The challenge is predicting which members carry overlapping needs, then having enough trained people to reach them.
Analytics tools and artificial intelligence platforms can surface those multi-measure members, and the HEDIS quality gaps they carry, in minutes. Turning that list into closed gaps takes a skilled, scalable outreach workforce that can pivot as your priorities shift through the measurement year. This is the core of scaling HEDIS seaosn workflows without losing quality.
3.) Facilitate the Appointment
Automated voice, text, and email outreach has become table stakes for member engagement, and it does lift wellness appointment scheduling. However, leaving members on their own to book a check-up or follow-up will still leave some of them stalled.
That is why improving HEDIS measures really requires a personal touch that guides members through scheduling and attendance.
For example, quality outreach professionals do not leave scheduling to chance. When your team calls a member who satisfies several HEDIS measures, they make the process simple: educate the member on the services that benefit them, help book the appointment with the provider, and walk them through that awkward first call. For the new caregiver support and glucose monitoring measures, that guidance is what turns an eligible member into a completed measure.
A strong outreach team also connects with the provider office to flag the HEDIS benchmarks that can be captured at the visit, which often unlocks pay-for-performance dollars for the provider. Those connections make appointments easier to keep and build the member trust that pays off in future measurement years.
4.) Blend Human Expertise With AI
The teams that lead on HEDIS MY 2027 are the ones that get the balance between people and AI right. Lean too hard on automation and members tune out the reminders, sensitive measures stall, and small data errors slip into your HEDIS reporting unchecked. Lean too hard on manual effort and you cannot keep pace with digital, ECDS-based measures or the volume they demand. The score goes to payers who let each side do what it does best.
Overcoming manual HEDIS constraints starts with letting AI and analytics carry the heavy, repetitive load. They stratify your population and flag who is due. Plus, they can surface the members who close several gaps at once, reconcile records for digital reporting, and handle routine reminders at a scale no team could match by hand. That frees your people from the busywork that used to eat their day.
Your outreach professionals carry the work AI cannot. They earn a hesitant member’s trust, walk a caregiver through a difficult decision, coach a member on glucose monitoring, and read the tone of a call well enough to know when to push and when to listen. They also keep judgment in the loop, reviewing what the AI produces before it reaches a member or a report. That discipline is what makes a proactive HEDIS reporting strategy hold up as volume climbs.
That blend only works with the right talent. The professionals who move the needle now are comfortable working alongside AI tools, acting on an AI-generated member list one minute and holding a genuine conversation the next. Finding and placing people who combine healthcare fluency with comfort in an AI-driven workflow is exactly the kind of specialized hire that takes a partner who knows the market.
Improving HEDIS Measures Requires the Right People, Processes, and Technology
All the above strategies, and the human and AI balance behind them, rely upon a well-trained team of quality outreach professionals who relate to members’ concerns and help them see proactive care as the path to better health. Moreover, it helps to have a scalable workforce that can pivot the moment your measure priorities change.
Standing up a division like that from scratch takes time, money, and the right talent to target services that fulfill several HEDIS measures at once. Thankfully, options exist that accelerate the time it takes for your quality outreach program to bear results.
Our experience across healthcare and insurance helps us unlock the potential of improving HEDIS measures by providing the training and the personnel to make a quality outreach initiative smooth and strategic.
Want to learn how to improve HEDIS measures? Here’s how we helped one payor achieve their HEDIS goals.
Improving HEDIS Measures FAQs
What is HEDIS, and why does it matter for health payers?
HEDIS (Healthcare Effectiveness Data and Information Set) is the standardized measure set most healthcare insurers use, shaping the plans of more than 235 million people. It gives employers and consumers a common way to compare quality, and strong performance protects your HEDIS ranking and your path to NCQA accreditation.
What is changing in HEDIS MY 2027?
MY 2027 brings six new measures, three updated measures, one measure moved to ECDS reporting, ECDS-reported measures reorganized by clinical domain, and minor adjustments across several others. The new measures target early colorectal cancer detection, congenital syphilis risk, caregiver support, and glucose monitoring for diabetes.
How do you improve HEDIS measures through member outreach?
Members rarely schedule the right care on their own, so you need outreach that reaches them before each measure’s anchor date. HEDIS outreach automation flags who is due, and trained people supply the human reminder and real conversation that move a member to book and attend.
How do you close HEDIS gaps in care efficiently?
Target members whose profiles satisfy several measures at once, because chasing one measure at a time is not cost-effective. Analytics surface the multi-measure members and the HEDIS gaps in care they carry, then a scalable outreach team closes several gaps in a single coordinated appointment.
How do you facilitate appointments so HEDIS measures actually close?
Automated reminders lift scheduling, though some members still stall on their own. Hands-on HEDIS support walks members through booking and attendance, and connects with the provider office to flag benchmarks captured at the visit, which keeps appointments and unlocks pay-for-performance dollars.
How do you balance AI and human expertise on HEDIS measures?
Let each side do what it does best. AI and analytics stratify your population, flag who is due, and reconcile records for digital reporting, which is central to overcoming manual HEDIS constraints. Your outreach professionals earn trust, guide sensitive conversations, and review AI output before it reaches a member or a report.
How do you manage HEDIS measures effectively over the year?
Align people, process, and technology, and keep a scalable workforce that pivots as priorities shift. Year-round HEDIS preparation and a partner who can manage HEDIS outreach end to end keep you steadily improving scores season after season.