3 Technology-Driven Strategies to Improve HEDIS Measurements and Medicare Star Ratings

3 Technology-Driven Strategies to Improve HEDIS Measurements and Medicare Star Ratings

November 8, 2021
David Emanuel

ImproveHEDIS Measurements and Medicare Star Ratings | VectorCare

Seniors have a plethora of Medicare Advantage plans and payers to choose from, which makes standing out of the utmost importance.

Improving your Healthcare Effectiveness Data and Information Set (HEDIS) measures and Medicare Star Rating is a great way to ensure you stand out from the competition. Plans with high HEDIS measures and Medicare Star Ratings make consumers' decisions easier as they know they'll receive quality, patient-centric care.  

What are HEDIS Measures and Medicare Star Ratings?

HEDIS is a standardized performance measurement used by consumers to gauge and compare healthcare plans. It’s one of the most widely used performance indicators and improvement tools, WITH 191 MILLION PEOPLE ENROLLED IN PLANS THAT REPORT HEDIS RESULTS.

Medicare Star Ratings are annually released ratings that reflect the plan's level of care to its members. Five stars represent the highest level of care, and one star indicates the lowest level of care.

Like HEDIS, Medicare Star Ratings help individuals make informed decisions about their medical needs. These performance indicators often go hand-in-hand as they both promote elevating members’ level of care.

Here are three strategies plans can employ to improve their HEDIS Measures and, in turn, their Medicare Star Ratings.

Create Patient Engagement and Incentive Programs

A common approach to improving HEDIS scores and Medicare Star Ratings is creating outreach programs that encourage healthy lifestyles and receiving preventative care. Contacting members and encouraging them to be proactive about their healthcare is no small feat, not only because of behavioral roadblocks but because of extensive transportation needs.

Using comprehensive technology such as VECTORCARE HUB helps plans:

  • Quickly identify who they should contact by having members’ entire medical history within one easy-to-use system.
  • Provide seamless and reliable non-emergency medical transportation (NEMT) services to members who need help getting to and from appointments or receiving their prescriptions and/or durable medical equipment (DME).

Once identified, staff can approach members directly and incentivize them to go to preventative screenings, get routine care, and participate in wellness activities—while also providing easily accessible NEMT services to get them there. A common tactic to improve wellness among members is through a beneficiary incentive program. These programs offer rewards such as gym memberships, gift cards, or cash to members who exhibit a healthy lifestyle.

Promote Payer-Provider Communication

Increasing the rate and ease of communication between payers and providers is another way to achieve higher scores and ratings. Payers and providers who regularly communicate can ensure any shared clinical documentation is accurate. Accuracy is paramount as data errors can cause significant issues for meeting HEDIS benchmarks and negatively affect Medicare Star Ratings.

Plans can then use accurate documentation to cross-reference completed member services and the services they may still need to identify gaps in care. A comprehensive technology solution such as VectorCare Hub streamlines this process as payers and providers can easily access shared documents and communicate within one system.

Boost Population Health Management

Both HEDIS and Medicare Star Ratings focus on the importance of population health. Population health management emphasizes members receiving the care services they need while keeping value and spending at the forefront. Ensuring members have reliable transportation to medical appointments and alternative means of getting DME and prescriptions are essential to the population health of your members.

Plans can ensure they are utilizing health care resources in the best way possible by analyzing member data to identify gaps in care. Many plans chose to create a cloud-based population health registry to understand and determine their members' needs and potential spending.

Payers can use this registry to:

  1. Predict spending for high-risk members
  2. Send information to primary care physicians and care managers regularly
  3. Initiate outreach to high-risk members to reduce spending and enhance cost-effectiveness

Realize Improved HEDIS Measurements and Medicare Star Ratings Through Comprehensive Technology

Implementing any strategies to improve performance indicators is made easier through the use of comprehensive, intelligent technology.

VECTORCARE HUB forges a new path to improved HEDIS scores and Medicare Star Ratings. Plans who utilize our technology can analyze complex data, create customized reports, and house all member information within one easy-to-use HIPAA-secure cloud-based system. Learn more about how Hub can improve healthcare dispatching.