HEDIS and Stars Quality Measure Improvement

Medicare Advantage health plans with direct Stars financial exposure know, months before the measurement window closes, which members are holding down specific measure scores. A member who has not had a glycosylated hemoglobin test in the measurement year is an open HEDIS CDC measure. A member who has not filled their statin for three consecutive months is an open Medication Adherence measure. The member is identified. The financial impact of non-completion is calculated. The window is still open.

The challenge is that knowing a measure is open is different from having the infrastructure to close it. Sending a letter that tells a member a test is due results in low response rates — not because members do not care about their health, but because a letter does not schedule the appointment, does not identify the reason the test has not been completed, and does not navigate the specific barrier that kept the member from completing it in the first place. The member who has not had their colorectal cancer screening has a reason. Cost, access, fear, previous negative experience, logistics. That reason does not appear in the claims data, and a generic outreach does not address it.

For health plans where Stars ratings drive plan revenue, per-member-per-month payments, and CMS bonus pools, HEDIS measure performance is a financial performance lever that affects the plan's margin materially. A plan that moves from three to four stars generates meaningfully higher revenue per member. The plan that knows which members and which measures represent the gap between those ratings — and still cannot close them before the measurement window ends — is leaving a known financial opportunity uncaptured.

ZynReminder runs HEDIS-specific member outreach — explaining the measure in plain language, identifying the specific reason the member has not completed it, and navigating the resolution in the same interaction. If the barrier is scheduling, ZynSchedule books the lab or visit at the member's preferred location and time before the call ends. If the barrier is cost or access, the interaction routes to a care coordinator or patient assistance resource.

The outreach scales across the full open-measure population simultaneously — not sequentially. A Stars quality team monitoring 12 HEDIS measures with thousands of open items per measure does not have to choose which measures to prioritize for outreach resources. ZynReminder runs the full population for every measure in the window, and the quality team receives completion tracking by measure, member tier, and closure timeline.

For health plan quality and Stars teams, the most useful metric is measure closure rate by week of the measurement window — how many open measures are being closed per week relative to the window deadline. Zynix AI provides that visibility in real time, which allows the team to identify measures where barrier rates are higher than expected and adjust the approach before the window closes.