Member Engagement Strategies That Improve HEDIS Measures and Patient Satisfaction
If your organization provides Medicare or Medicaid insurance plans, the Healthcare Effectiveness Data and Information Set (HEDIS) acts as the scorecard that shows just how well you’re caring for your members.
HEDIS, developed by the National Committee for Quality Assurance (NCQA), is a standardized set of performance measures that are used to assess the quality of care that healthcare organizations provide to their patients. The Centers for Medicare and Medicaid Services (CMS) requires many health insurance plans to report their HEDIS data as a part of their Medicare Star Ratings—as such, HEDIS data can have a strong effect on a provider’s revenue and enrollment.
While health outcomes are a significant part of HEDIS measures, communication, engagement, and patient satisfaction play a key role as well. So, if you’re looking to improve your organization’s HEDIS performance, you may want to take a look at your member engagement and communication strategies.
In this blog post, we’ll take a deeper look at what HEDIS is and how health plans can improve their performance by rethinking their engagement strategy.
Table of Contents
The Link Between Member Engagement and HEDIS Performance
Common Barriers to Effective Member Engagement
Inclusive, Accessible Member Correspondence: The Foundation of Engagement
Member Engagement Strategies That Directly Impact HEDIS Measures
Measuring Success: Tracking HEDIS Improvement Through Engagement
Avantpage’s Role in Supporting Better HEDIS Outcomes
Frequently Asked Questions About HEDIS Measures and Member Engagement
Your Message, Measured: Turning Communication Into Better Outcomes
What Are HEDIS Measures?
More than 235 million people across the United States are enrolled in health plans that report data on HEDIS measures, making it one of the most widely used performance improvement and quality assurance tools in the healthcare industry. The NCQA uses around 90 different HEDIS measures to evaluate health plans. These measures are organized into six domains of care:
- Effectiveness of Care: This domain looks at preventive screenings, chronic condition management, and outcomes for specific health conditions.
- Access/Availability of Care: In this domain, HEDIS measures determine whether members can obtain timely care, including appointments and provider availability.
- Experience of Care: HEDIS measures in this domain include patient satisfaction and perceived quality through surveys.
- Utilization and Risk-Adjusted Utilization: Here, plans look at how often members use their services and whether care is appropriate for their risk profiles.
- Health Plan Descriptive Information: This domain aims to provide context on plan characteristics, demographics, and enrollment.
- Measures Reported Using Electronic Clinical Data Systems (ECDS): This domain captures clinical data directly from electronic health records to improve reporting accuracy and timeliness.
By collecting and analyzing this data, HEDIS enables health plans to monitor performance and improve member outcomes. HEDIS measures are also an important way to meet regulatory requirements, while giving members and stakeholders a transparent, standardized way to compare the quality of care across plans.
The Link Between Member Engagement and HEDIS Performance
Member engagement is a way to improve your performance on HEDIS measures—when members understand their benefits, feel connected to their care teams, and receive timely, accessible communication, they’re more likely to schedule preventive visits, complete screenings, and adhere to treatment plans. This in turn improves a health plan’s scores in HEDIS domains like Experience of Care and Utilization and Risk-Adjusted Utilization.
It should come as no surprise then, that health plans with strong engagement strategies consistently report higher HEDIS scores, especially when outreach is personalized, multilingual, and easy to understand. When health plans successfully engage their members, members feel more trust toward their health insurance provider, leading to improved patient satisfaction and an increased willingness to use their health insurance and advocate for themselves within the healthcare system.
Research shows that improved care coordination—a form of member engagement involving “the deliberate effort by two or more healthcare professionals to facilitate and coordinate proper delivery of care to a patient”—also leads to improved performance on HEDIS measures, often by more than five percentage points.
Common Barriers to Effective Member Engagement
Below are a few examples of some common issues health plans encounter when trying to boost member engagement:
– Limited language access: It’s hard to engage members if you’re not speaking their language. If you don’t offer thorough medical translation and interpretation services, members with limited English proficiency are much less likely to make use of their health plan.
– Poor health literacy: All too often, health plans communicate to their members in jargon-laden benefits letters, notices of action, and other media. But this can be difficult for patients to understand, making them less likely to engage and utilize their insurance.
– Outdated outreach methods: While there’s certainly a place for print media and letters, keep in mind that many members prefer to use more modern means of communication like email, text message, and online member portals.
– Limited accessibility: Without options like large print, screen-reader compatible digital content, or ADA-compliant materials, members with disabilities are less likely to understand their benefits, complete preventive care, or follow through on recommended screenings.
Improving member engagement starts by tackling these problems head-on. By developing a more accessible communication strategy, you can better engage your members and boost your organization’s performance on HEDIS measures.
Inclusive, Accessible Member Correspondence: The Foundation of Engagement
Effective member engagement begins with clear communication. Inclusive and accessible correspondence ensures that all members, regardless of language, literacy level, disability, or cultural background, can confidently navigate their care. This involves using plain language, ADA- and Section 508-compliant formats, multilingual materials, and multiple communication channels.
Members who receive clear, understandable messages are more likely to schedule preventive screenings, follow treatment recommendations, and complete necessary follow-ups. Examples of inclusive communication include sending appointment reminders in a member’s preferred language, providing visually clear benefit explanations, and offering audio or video versions of critical information for those who need alternative formats.
This foundation of trust and clarity empowers members to take charge of their care and directly supports HEDIS measures related to Effectiveness of Care, Access/Availability, and Experience of Care. In short, even the best care programs may fail to reach the members who need them most without accessible correspondence.
Member Engagement Strategies That Directly Impact HEDIS Measures
Below, we’ll take a look at five different strategies that health insurance providers can take to improve their communication and member engagement strategies.
Strategy 1: Use Data-Driven Personalization to Improve Effectiveness of Care
Tailor outreach to each member based on demographics, claims history, and identified care gaps. Personalized reminders for screenings, vaccinations, and chronic condition management increase adherence and close gaps, directly improving HEDIS measures like Effectiveness of Care.
Strategy 2: Simplify Access and Availability of Care with Clear Correspondence
Ensure appointment notices, telehealth links, and coverage information are easy to understand and accessible in multiple formats. Using mail, email, SMS, and portal notifications reduces barriers and encourages timely care.
Strategy 3: Build Trust to Enhance Experience of Care
Use inclusive language, culturally relevant translations, and community-specific messaging to foster respect and belonging. When members feel respected, they tend to report higher satisfaction. This improved satisfaction goes hand in hand with improved member engagement, as members are more likely to trust and engage with their health plan if they feel satisfied with it.
Strategy 4: Close the Loop on Utilization and Risk-Adjusted Utilization
Encourage preventive visits and follow-ups with personalized outreach to plan members. Automated systems can flag members who are overdue for screenings, which will help your organization manage utilization and ensure appropriate care delivery.
Strategy 5: Leverage Technology for Member Engagement
Integrate AI, automation, and translation tools to scale outreach while maintaining accessibility and language compliance. Technology ensures timely, consistent communication that reaches all members and supports better performance on HEDIS measures. However, it’s important to integrate technology carefully—there should always be a human in the loop to review the messages you’re sending out.
Measuring Success: Tracking HEDIS Improvement Through Engagement
Once you’ve implemented the above strategies and begun working to improve your member engagement, there are a few key metrics you can look at—aside from overall HEDIS scores—to determine the success of your efforts:
- Participation rates
- Appointment completion
- Satisfaction surveys
As you track member engagement and HEDIS improvement, try to establish feedback loops that capture member responses and interaction data. For example, after sending out preventive care reminders, you can track open rates, click-throughs, appointment completions, and survey feedback. These insights allow you to adjust messaging, choose the most effective communication channels, and personalize outreach for different member populations.
And keep in mind that improving member engagement is an ongoing process—the way we communicate today is very different from the way we communicated 20 years ago. That means that your engagement strategy needs to be constantly evolving to meet the ever-changing needs of your members.
Avantpage’s Role in Supporting Better HEDIS Outcomes
At Avantpage, we’ve recently launched a tool to help you improve member engagement and boost performance on HEDIS measures: AvantSend.
AvantSend is our new, AI-enabled correspondence platform that supports 150+ languages and ensures ADA and Section 508 compliance. This platform handles all of your communication needs, from translating letters to printing them out and mailing them directly to your members, speeding up the turnaround time for delivery by about two days.
Here’s an example of how you can take advantage of AvantSend: Using AvantSend, a health plan was able to automate end-to-end mailing of preventive screening reminders, including multilingual and ADA-compliant formats. By tracking responses and appointment completions, the organization was able to follow up with members who hadn’t scheduled screenings, ultimately increasing participation rates and closing care gaps more efficiently.
By streamlining your communications workflow and getting correspondence out to your members faster, AvantSend boosts member satisfaction and bridges gaps in care—in turn boosting your HEDIS performance.
Frequently Asked Questions About HEDIS Measures and Member Engagement
What are HEDIS measures used for?
HEDIS measures are standardized performance metrics used by health plans and the NCQA to evaluate care effectiveness, accessibility, experience, and utilization.
How does member engagement affect HEDIS scores?
Higher engagement leads to better follow-up, preventive care, and satisfaction — directly improving scores in domains like Effectiveness of Care and Experience of Care.
What are examples of engagement strategies that improve HEDIS performance?
Personalized outreach, multilingual materials, accessible appointment reminders, and culturally responsive communication all boost engagement and HEDIS outcomes.
How does inclusive communication help improve patient satisfaction?
When members understand their benefits and next steps, they feel respected and informed — leading to higher satisfaction scores and stronger plan loyalty.
How can technology platforms like AvantSend improve HEDIS results?
AvantSend automates inclusive, ADA-compliant, multilingual member correspondence — helping health plans communicate clearly and consistently across all populations.
Your Message, Measured: Turning Communication Into Better Outcomes
Clear, inclusive communication is essential for helping members understand their benefits and take advantage of them.
Ultimately, when communication is inclusive and intentional, members are more engaged, overall satisfaction improves, and your HEDIS measures get even better. In this sense, a good communication strategy can be seen as a clinical quality tool, rather than just a small administrative task.
If you’re looking to boost your HEDIS performance, Avantpage can help. We offer translation, interpretation, and accessibility services that can transform the effectiveness of your communication strategy. And that’s not to mention our latest development, AvantSend. Get a free quote online or call (530) 750-2040 to learn more about how we can help you modernize member correspondence and drive measurable quality outcomes.
