Improve Your HEDIS Score by Addressing Social Determinants of Health


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More than 90% of health plans use Healthcare Effectiveness Data and Information Set (HEDIS) to measure their performance. With 90 measures covered across six domains of care, everything from child immunization rates to emergency department utilization is included.  

While social service referrals aren’t necessarily included in the measurement tool, addressing social determinants, like non-emergency medical transportation needs or poor diet, can improve HEDIS scores and contribute to a higher ROI.  

The National Committee for Quality Assurance (NCQA) recommends collecting information on anything that influences a patient’s overall safety, risk factors, health, and well-being, which would include socioeconomic factors, like housing, food insecurity, and transportation needs. For health plans to achieve high HEDIS scores - and accreditation by NCQA - it’s important to not only prioritize and track SDoH data but develop SDoH interventions that properly meet members’ social needs. 

How to leverage SDoH data and social services networks 

Many health plans are already utilizing SDoH initiatives to achieve better health outcomes and reduce costs, but how can these efforts improve your HEDIS score?  

Here are a few examples: 

  • Provide non-emergency medical transportation to members. If you have a pregnant member without access to a car or public transportation, they may miss their prenatal care visit in the first trimester. To ensure this HEDIS measure is accounted for, health plans can offer pregnant members reliable transportation services, which can easily be accessed and tracked through an in-network platform like Healthify. 
  • Make behavioral health services available to members with substance use disorders. When there’s a high use of emergency department visits for members with substance use disorders, it’s often due to lack of treatment or care. Health plans can improve their HEDIS score by building stronger relationships with social service providers who offer behavioral health services and support for those battling an alcohol or substance use disorder.  
  • Prioritize housing services. Studies show that people with social risk factors like homelessness can have healthier outcomes when their basic needs are resolved. Homeless members may not have the means or the communication methods needed to address their health needs, which can lead to missed care appointments, disrupted medication management, or failure to comply with treatment recommendations or follow-up care. Addressing housing needs will not only improve your members’ health, but will help you achieve certain HEDIS measures. 
  • Supply nutritious food to members with high blood pressure, obesity, and other chronic conditions. Measures for members with chronic illness often include medication compliance and management, but diet has proven to be one of the best ways to improve chronic health. Providing members with nutritious meals, food education, and other food services can improve chronic health management and care. This can help support measures of Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents and Comprehensive Diabetes Care, among others. Health plans should build relationships with local organizations in order to make food services easy to access.  

In order to improve your HEDIS scores, care must be accessible, effective, and of high quality. Working with community organizations, health plans have the opportunity to improve their own performance, while properly addressing the social determinants that often prevent members from achieving optimal health outcomes.  

With Healthify, powered by WellSky, health plans can not only increase access to social services, but work closely with community organizations to track and monitor closed-loop referrals. Our integrated, interoperable system makes it easy for payers to address SDoH and improve their HEDIS score in the process. 

To learn more about Healthify please contact us now. 

Topics: Healthify healthcare delivery social determinants of health SDoH data

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