Improving HEDIS Measures: How to Optimize Your Member Engagement

Dec 7, 2016

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 90% of America’s health plans. Having everyone speaking the same language rewards merit over false status. However, 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 2021 HEDIS reporting season has its own touchstones. The NCQA has made sweeping adjustments to 40 common HEDIS measures, adapting the standard quality improvement measures to fit the current modality popularized by the COVID-19 pandemic. Regardless of prevailing conditions, these three straightforward changes in your overall approach to quality measures can help to better improve healthcare member engagement.

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1.) Effectively Use Outreach Programs to Approach Members

Regularly fulfilling HEDIS measures requires getting 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 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 a year of social distancing, many of the traditional on-site tests and procedures will be negatively impacted, but 2021 HEDIS reporting has revised or prioritized measures that reflect proactive telehealth engagement. Outreach will now need to educate and train members to use telemedicine platforms, encouraging them to satisfy multiple virtual measures at once to mitigate the impact on traditional HEDIS measures.

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 big data analytics is the route to enhancing the efficiency of those calls.

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 high blood pressure, 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. Advanced analytics platforms, on the other hand, automate the review process and parse through millions of digital files (if you’ve already successfully been breaking data silos) to find areas of overlap. From there, your outreach initiatives can be prioritized based on those people who satisfy multiple HEDIS measures with one encounter or visit.

As a result of the coronavirus, it’s even more essential to identify any overlapping conditions (especially those that can be comorbidities with COVID-19) to help members treat conditions and compel them to take the necessary precautions to avoid exposure to SARS-CoV-2.

3.) Facilitate the Appointment

Traditionally, health plans have relied on physical mailers and emails to encourage members to make their own appointment. But a reminder about scheduling wellness appointments only takes members so far. 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 outreach to the provider office to alert them to the possible HEDIS encounters that can be captured at the time of the appointment which 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 of 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. During the COVID-19 crisis, it’s of particular importance that these outreach professionals are able to excel in a remote work environment and 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 this HEDIS reporting season and any in the future.

Improving HEDIS scores depends on deploying the right talent. Start your HEDIS season off right by making time to talk with one of our staffing specialists.




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