Improving HEDIS Scores Through Digital Communication and Engagement

​HEDIS, the Healthcare Effectiveness Data and Information Set, is a vital set of measures, developed by the NCQA, that evaluates the quality and effectiveness of healthcare payers and providers. Payers and providers are assessed based on their performance in meeting these measures, and the results are compiled into HEDIS scores. Healthcare organizations use HEDIS scores to identify areas for improvement, showcase their quality standards to stakeholders, and gain a competitive advantage in the marketplace, so it is important for them to continuously work toward improving their HEDIS scores.

For more details on HEDIS, we have an entire blog post dedicated to HEDIS measures and scores that can be accessed here.To read more about HEDIS measures, technical resources, submission timelines, and other information, visit the official NCQA website for HEDIS and Performance Measurement.

The HEDIS abstraction process, which includes the collection, review, and reporting of clinical data used to determine HEDIS scores, is limited to a few months a year, but the process of improving HEDIS scores is something that payers and providers can work toward year-round. Improving HEDIS scores requires patients and members to take specific actions that are related to HEDIS measures. For example, some of the things that patients and members can do to help improve HEDIS scores are, scheduling and completing preventive care appointments, maintaining immunizations, and adhering to specific medications, among many other things. So, how can payers and providers ensure that patients and members take the actions that are correlated to HEDIS measures? Using digital communication tools.

In another one of our blog posts around HIPAA compliant texting, we discuss the prevalence of digital tools in healthcare today. Since the pandemic, consumers have dramatically shifted their preferences for digital tools across all areas of their lives, including in healthcare. Effectively communicating and engaging with members and patients using digital tools, like HIPAA compliant platforms, can make a significant difference in their ability and willingness to take action on the items that impact HEDIS scores. Digital communication tools play a critical role in improving HEDIS scores by enhancing patient engagement, addressing care gaps, and supporting access to care. Here’s how:

Digital tools make it easier to connect with patients by delivering timely, actionable health information and reminders. Using digital communications tools, members and patients can seamlessly schedule screenings, designate PCPs, complete health risk assessments (HRAs), and connect with health coaches—all in one place. By simplifying these actions, healthcare payers and providers can ensure that patients and members complete necessary preventive care and chronic disease interventions, directly improving HEDIS measures.

Digital tools enable healthcare organizations to identify gaps in care and patients or members at risk of poor outcomes. Targeted outreach, such as reminders for cancer screenings, vaccinations, or chronic condition management (e.g., diabetes care), ensures patients and members receive the care they need. These interventions are vital for improving HEDIS measures across key domains, like Effectiveness of Care, while driving better health outcomes.

Educating patients and members is critical for improving HEDIS scores related to care coordination and chronic disease management. Digital communication tools can be used to deliver tailored educational content at scale, helping members and patients better understand benefits, appropriate emergency department usage, and care coordination. By promoting management of conditions and resource awareness, healthcare organizations can improve adherence and engagement with their care plans.

Additionally, as HEDIS measures evolve and change, healthcare organizations can use the same digital tools to get ahead of those changes with members and patients to help them prioritize the actions aligned to those new measures. In fact, if you are interested in learning more about the changes to HEDIS in the coming year, we outline some of the updates in our blog post, “Understanding HEDIS Measures: What You Need to Know Heading into 2025 and Beyond.”

Access to care is a foundational measure for improving HEDIS scores, as it directly impacts a patient’s ability to receive timely and effective healthcare. Digital tools play a vital role in eliminating barriers to care, whether they are physical, logistical, or cultural, ensuring that members can seamlessly connect with the services they need. Here’s how digital communication tools enhance access to care and contribute to improving HEDIS performance:

The impact of using digital tools for improving HEDIS scores is clear, but with so many options available, which is the most effective for healthcare organizations to adopt and use? Let’s consider a few here:

While all of these digital tools can be effective, not all digital tools are created equal. According to the 2024 J.D. Power US Healthcare Digital Experience Study, “one-third of health insurance websites and apps don’t meet the level for ‘intuitive organization of information.’” An effective digital communication tool and aligned strategy are critical for healthcare payers and providers to deliver important information to their members and patients that drive outcomes, like improving quality scores, that they desire. But if their digital tools aren’t meeting member expectations for design and experience, they may not see results.

That’s where Relay Feeds come in. Through the unique design of the channel: a personalized, secure text message to HIPAA compliant scrolling feed, members and patients can access their messages easily and take action at the scroll of a thumb. Feeds are preferred by consumers today because of their intuitive design and bite-sized pieces of content, and the Relay Feed is no different. In fact, Relay conducted a study that found that “seventy-two percent of respondents say they’re more willing to engage with their health insurance provider on a regular basis if provided content that was personally relevant in a feed format.”

Relay Feeds have been instrumental for our healthcare payer and provider clients in driving the outcomes important to improving HEDIS scores. One Relay client attributed an improvement in 16 out of 24 HEDIS measures, upwards of $1.3 million in cost savings, to their Relay program. If you want to learn more, check out our eBook below highlighting Relay’s ability to influence member action toward specific HEDIS measures.

Download our eBook on How to Improve HEDIS Scores by clicking the image below:

Click to Download eBook

As another example of digital tool success, in one of Relay’s webinars, “Enhancing Quality Scores in Healthcare with Digital Tools,” Prospect Medical, shared an example of how they are using Relay Feeds to help with access to care.

Read the full webinar recap here, with a plethora of insights related to improving HEDIS scores as well as other quality measures.

By integrating digital communication tools, like Relay Feeds, healthcare organizations can improve their performance on quality measures, thereby achieving better HEDIS scores. These improvements not only reflect higher quality and efficiency of care but also can lead to better health outcomes for members.

To learn more about how Relay can help with driving actions to improve quality scores, check out our eBook or reach out to sales@relaynetwork.com.

To experience your own Relay Feed delivered to your phone, click the button below. 

For more comprehensive information about HEDIS, you can refer to the official NCQA website dedicated to HEDIS.

HEDIS measures consist of over 90 measures that sit across six critical domains of care: effectiveness of care, access/availability of care, experience of care, utilization, health plan descriptive information, and risk adjustment utilization. Among the most common measures, HEDIS tracks performance in areas such as preventive care, chronic disease management, and mental health services, reflecting its broader aim to prioritize proactive and holistic health management. These measures create a consistent framework for maintaining and enhancing care quality, enabling healthcare payers and providers to benchmark their performance and strive for continuous improvement. Payers and providers can use HEDIS measures as point of reference for developing strategies that not only improve patient care, but also assist payers and providers in meeting regulatory and financial goals.

NCQA, HEDIS Data Submission

NCQA, HEDIS