Having a high HEDIS score can have a major impact on a health plan’s long-term profitability and viability.
In large part, that’s because HEDIS scores can influence the numbers of individuals who will sign up for a given plan in the future. And because the performance bonuses that CMS provides annually to plans with high Star Ratings are calculated per member, they can add up to significant amounts of money. In fact, for large health plans, these bonuses can total many millions of dollars per year .
Most importantly, the HEDIS system is designed to measure the quality of healthcare. Achieving a higher HEDIS score typically indicates better healthcare performance, ultimately leading to better health outcomes for a health plan’s members.
In other words, the most crucial aspect of improving your health plan’s HEDIS score is boosting the actual quality of the care you provide.