The Healthcare Effectiveness Data and Information Set (HEDIS) is the most important tool health plans use for measuring clinical performance and plan quality. HEDIS is administered by the National Committee for Quality Assurance (NCQA), which collects the data and evolves the HEDIS measurement set annually. Over 90% of plans, enrolling 191 million Americans, use HEDIS annually to measure their performance.

HEDIS matters to plans, as NCQA plan accreditation is based on HEDIS results combined with Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, and for Medicare plans, CMS’ Health Outcomes Survey (HOS). Raising HEDIS scores in what HEDIS measures--over 90 measures organized into eight domains--is thus an annual priority for health plans.

How can plans improve HEDIS scores?

Better performance across HEDIS domains engages members by improving the member experience, their satisfaction, and health outcomes. Effective programs for members at all risk levels personalize the experience and motivate them to effectively participate in improving their health. One approach that plans have taken is to actively work with their members and influence behavior that they become more proactive in adopting activities that can influence their overall health.

The broad scope and evidence-based content of Krames programs can support members in better understanding their health. They can boost participation in the member health journey, wherever they may be.

How do Krames programs relate to 2022 HEDIS domains?

Krames produces a range of evidence-based, culturally appropriate educational materials in practical formats that promote health understanding. The following are three examples of Krames programs and the HEDIS domains they support.

Go-to-Guides

Krames Go-to-Guides (GTGs) are digital interactive ‘flip’ workbooks that present lifestyle, nutrition, and health information in involving, engaging plain language. The interactive GTG flip workbooks sustain patient engagement with chronic disease management while creating opportunities for families to participate in care. These accessible workbooks discuss lifestyle, nutrition, and health routines and address a range of conditions and illnesses.

Topics covered in GTGs include:

• After a stroke: A guide for stroke recovery and prevention
• Living well with heart failure
• Living well with heart disease
• Living well with diabetes
• Living well with asthma
• Living well with chronic lung disease

GTGs are easy for members to share with caregivers and family members as they are accessible through a web link. Offered in print and digital forms, as well as in English and Spanish, they are fully 508 compliant.

• The format of the digital guides adapts to different learning styles by including audio voiceover for text, videos to visually explain physiology and medical concepts, rollover text to explain the content in everyday language, and quizzes to reinforce learning.
• GTGs include logs and action plans designed for members to personalize and print out for motivation and guidance. These guides can be customized, from your plan logo to additional features such as topics and specific content.

Go-to-Guides support measures within the HEDIS domains of Effectiveness of Care, Measures Collected Through the Medicare Health Outcomes Survey, Experience of Care, and Utilization and Risk-Adjusted Utilization.

Consumer Health Library

The Consumer Health Library (CHL) is Krames’ digital solution that is integrated into a health plan’s website. Plans use it not only as an educational and community resource, but also to add marketing “stickiness” as an additional ‘go-to’ resource for members at any risk level and their families.

While this resource adds value for all health plan members, CHL also has the advantage of attracting and engaging even low-risk members with timely content, video, quizzes, and checklists that collectively contribute to member health understanding. Content is updated quarterly with seasonal reminders for checkups, exercise, vaccinations, and healthy lifestyle advice.

The Consumer Health Library supports measures within the HEDIS domains of Effectiveness of Care, Measures Collected Through the Medicare Health Outcomes Survey, Measures Collected Through the CAHPS Survey, Access/Availability of Care, and Experience of Care.

Custom Content Solutions

Custom Content Solutions (CCS) creates print, direct mail, and digital solutions, including fulfillment and delivery, for content and promotional marketing. These are tailored to a plan’s specific requirements and produced to be unique to the plan. The expertise, process, and rigorous clinical content development featured in all Krames materials is incorporated in developing these fully customized materials and programs.

Krames CCS is highly experienced in supporting cultural, ethnic, and age diverse member populations. Programs used by plans include reminder postcards, blogs, condition-specific newsletters, e-letters, calendars, recipe books, and more.

Depending on the program and content, Krames Custom Content Solutions can support measures within the HEDIS domains of Effectiveness of Care, Measures Collected Through the Medicare Health Outcomes Survey, Measures Collected Through the CAHPS Survey, Access/Availability of Care, Experience of Care, and Utilization and Risk-Adjusted Utilization.

Read more about Krames’ approach to health education and how it can influence plan HEDIS scores in our white paper, Heightening HEDIS: How Krames health information programs can help you achieve your plan’s objectives.

Learn more about Krames and our complete suite of care management and member wellness programs at https://www.krames.com/health-plans. From discovery to recovery, Krames is here to activate health with empowering content, engaging education and marketing, and intelligent, integrated clinical workflow solutions. To learn more, visit krames.com or connect with us on LinkedIn, Twitter, and Facebook.