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Strengthen HEDIS Performance with Digital Member Engagement

Published Date
Author HealthEdge

Quality performance expectations have reached a turning point in 2025. This year’s Healthcare Effectiveness Data and Information Set (HEDIS) measures, developed and maintained by the National Committee for Quality Assurance (NCQA), place greater emphasis on preventive care, chronic disease management, and social determinants of health (SDOH). These updates require health plans to adapt quickly to remain competitive. 

To meet these elevated expectations and strengthen HEDIS performance, health plans must engage members as active partners in whole-person care. This means going beyond clinical interventions to promote preventive screenings and address social barriers. The HealthEdge Wellframe™ member engagement platform supports this shift by enabling health plans to transition from reactive workflows to proactive, measurable quality improvement strategies using digital tools. 

Adapt to A Shifting Quality Measurement Landscape 

NCQA continues to evolve HEDIS to better reflect whole-person care, with three core areas defining 2025’s elevated standards: 

  • Engagement-Driven Prevention. New metrics measure how effectively health plans engage members to follow through on preventive care, including screenings, immunizations, and early interventions. Documenting that services occurred is no longer sufficient—health plans must demonstrate improved health outcomes and health risk reduction. This shift rewards organizations that foster relationships and use tools such as digital engagement to promote preventive clinical best practices. 
  • Whole-Person Quality Metrics. HEDIS measures now incorporate SDOH, such as housing, food access, and transportation. Health plans are expected to address medical, behavioral, and social factors of members’ lives. Through partnerships with community-based organizations (CBOs) and the use of closed-loop referrals, health plans can reduce barriers to quality care. 
  • Real-Time Performance Standards. Expectations from NCQA and the Centers for Medicare & Medicaid Services (CMS) increasingly require standardized, real-time clinical quality data analysis. Health plans must refine their existing clinical quality and risk adjustment initiatives to show a commitment to improving outcomes, reducing disparities, and advancing value-based care across Medicare, Medicaid, and Marketplace programs. Similar to Star Ratings, HEDIS measures play a central role in health plans’ clinical quality strategy. To stay aligned, health plans must shift from batch reporting to continuous monitoring that identifies care gaps and tracks interventions as they occur. 

In this context, persistent operational and data analytic challenges remain for many health plans. Fragmented data sources limit visibility into members’ needs and delay outreach from care teams, making it difficult to close gaps in a timely manner. Many care teams rely on outdated manual processes that use multiple technology platforms, creating additional barriers and requiring an increasing amount of administrative resources. Traditional approaches cannot guarantee that care gaps are addressed before they negatively impact clinical quality measures. 

At the same time, the financial risks are growing. Low HEDIS performance can lead to significant penalties, while top-tier scores boost Star Ratings and member acquisition. As more value-based care contracts link payment to quality, the stakes for health plans are higher than ever. 

Transform Strategy & Strengthen HEDIS Performance with Wellframe

Wellframe helps health plans meet evolving requirements by embedding digital member engagement into clinical quality operations. This integration accelerates care delivery, enhances member support, and enables a more responsive, whole-person approach.  

Real-Time Intelligence Drives Early Action

Wellframe captures data as members interact with the platform, surfacing care gaps and risk signals earlier. Digital surveys, screening tools, and health assessments offer insights into both clinical and non-clinical needs. 

Predictive capabilities enable Wellframe to identify care gaps and surface them so care teams can conduct individual or group outreach.  For example, pregnant members may receive timely reminders to schedule prenatal visits, while members managing diabetes receive personalized nudges for HbA1c testing and eye exams. These early interventions help maximize impact within quality measurement windows. 

This intelligence enables care teams to take proactive steps to encourage screenings, address chronic conditions, and respond to emerging concerns before they escalate.  

Member-Centered Engagement Builds Stronger Connections 

Wellframe supports member engagement across multiple touchpoints, including two-way messaging with care teams, personalized push notifications, and tailored educational content delivered through the mobile devices members use every day. 

This model improves adherence to screenings, diagnostic testing, and treatment plans that influence HEDIS measures. By meeting members where they are and offering convenient, personalized experiences, Wellframe turns passive engagement into active participation. 

Personalized Programs Support Whole-Person Care 

Managing chronic conditions, maternal health, or preventive goals requires more than one-size-fits-all communication. Wellframe delivers customized digital care programs tailored to each member’s circumstances, including known social risk factors. 

Members experiencing food insecurity can be referred to community-based support. Individuals facing transportation challenges may be eligible for transportation assistance to attend in-person appointments. These personalized interventions drive better health outcomes and higher quality scores. 

Demonstrable Value Delivered by Wellframe

Wellframe delivers measurable results across quality metrics, operations, and member experience, such as: 

  • Enhanced Care Team Efficiency. Care teams using Wellframe can scale their outreach while continuing to deliver personalized support. According to HealthEdge data, health plans have doubled their active caseload capacity and increased member interactions up to sixfold by leveraging intelligent workflows that automate routine tasks, streamline documentation, and prioritize high-risk members. This enables care teams to facilitate care gap closure and enhance coordination across health plan clinical quality and compliance teams. 
  • Higher Member Satisfaction. Members consistently rate their experience with Wellframe highly (an average of 4.7 out of 5 stars in the App Store). For many members, digital communication lowers barriers to care and fosters stronger relationships with their health plan. Satisfied members are more likely to complete screenings, adhere to care plans, and engage long-term to strengthen overall performance. 

Building a Future-Focused Quality Strategy

HEDIS measures reflect how effectively health plans deliver quality, equitable, and consistent care. As expectations rise, digital transformation is essential. 

Wellframe enables timely outreach, tailored education, proactive reminders, and transparency in the care journey. Integrated with care management systems, these tools help health plans close whole-person care gaps more efficiently, engage members at risk, and align with top HEDIS priorities. 

As NCQA and CMS continue to evolve value-based care and clinical quality standards, Wellframe evolves alongside them. With HealthEdge, health plans gain a strategic partner committed to continually improving member outcomes and advancing equity, member engagement and operational performance. 

Strengthen HEDIS performance at your health plan with digital member engagement. Learn how Wellframe helps health plans deliver proactive outreach, close care gaps faster, and elevate the member experience.