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Improving Member Engagement and HEDIS Scores


Between wrapping up year-end work and preparing for the holidays, the fourth quarter is the busiest time of year for most people.

Yet, health plans often wait until then to squeeze as many of their members as possible into provider offices to address HEDIS® measures and close gaps in care before the year ends.

As a result, they’re putting both their population’s health and plan performance at risk.

Avoid the Year-End Crunch
Obtaining a timely, in-person medical appointment at anytime during the year can be a challenge due to the nation’s growing physician shortage, insurance coverage expansion, an expanding and aging population, and increasing prevalence of chronic disease.

Booking a medical appointment at year-end can be even more challenging.

Year-end appointments are often in high demand as health plans strive to close gaps in care and meet their annual HEDIS goals by getting their members into providers for exams and health screenings.

Provider offices are also inundated with people who have money remaining in their flexible spending account rushing to spend it before they lose it, and with those who have met their insurance deductibles scrambling to take advantage of cost savings before the calendar flips.

The fourth quarter is also the busiest time of the year for many people, both professionally and personally, thus making it even more difficult to schedule medical appointments.

Limited provider availability and appointment scheduling challenges contribute to member frustration, higher noncompliance rates, and services performed outside of the recommended timeframe and plan network.

Implement a Year-Round Approach
The most successful health plans manage HEDIS as an ongoing year-round program versus a short-term annual project.

A year-round approach with multiple touch points is essential for increasing member engagement and compliance, improving HEDIS results and containing costs.

Proactive, strategically timed interactions throughout the year create a continuous feedback loop between a health plan and its members. This results in more timely collection of key information that enables customer service issues, gaps in care and adverse health conditions to be identified and addressed before they escalate and lead to costly complications.

Regular, personalized contact also increases member engagement, compliance and satisfaction by building rapport and a deeper, more trusting relationship between a plan and its members.

Best Practices for HEDIS Success
With nearly 30 years of working with close to 100 healthcare clients and millions of people across all populations, Carenet Healthcare Services has developed a finely tuned compilation of best practices, including year-round member outreach, for successfully closing gaps in care and boosting HEDIS scores.

To learn more, download Carenet’s new e-book HEDIS Best Practice Guide: Proven Strategies for Closing Gaps in Care.

View E-book

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


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