Improving HEDIS scores through member navigation and health-related social needs

Health literacy, noun: A person’s ability to understand the information that helps them make well-informed health decisions.

The Healthcare Effectiveness Data and Information Set (HEDIS) hones in on quality, access and member satisfaction. It measures literacy by looking at a member’s ability to understand their health plan, act on their benefits and meet the clinical goals.

That also means provider organizations need to be able to lead the way, making a plan to foster literacy within your organization and its membership to close care gaps. One thing to remember: A hidden element may be impacting your members’ health-related social needs, keeping them from engaging and adhering to their care plans.

Improve your HEDIS measures and meet members where they are by becoming a partner and an advocate to solve their needs hiding in plain sight.

Why does organizational health literacy matter?

Health care is a maze for anyone to navigate, including clinicians, providers, members and even patients themselves. Most members don’t know enough to act on their own. In fact, 9 out of 10 adults don’t understand their health well enough to take action. This can have dire consequences.

Take proactive steps to elevate your organization and empower members to face their health-related social needs, like these:

1. Learn what makes your organization health literate.

Health-literate care organizations help people navigate and use services to maintain their well-being. They do so by empowering members to access services and take action toward positive outcomes, including:

• Integrating navigation and literacy into care planning to ensure patients follow instructions and reduce medical waste.
• Communicating to confirm member understanding along the way.

2. Understand your organization’s alignment with health literacy.

Is your organization on top of its game? Optimize your performance with the Centers for Disease Control and Prevention’s (CDC’s) Health Literacy Assessment. The tool reveals data-driven barriers to how your organization educates itself and empowers members, complete with general assessments and resources to help make health information more accessible.

3. Implement your action plan.

Start thinking about what your organization could do to get to the next level. The CDC offers a framework for developing a health literacy plan to enhance your organization and keep growing member engagement. Bookmark it as a handy guide to drive your HEDIS reporting.

4. Get staff up to speed on health literacy training.

Empowerment goes both ways. Lay the groundwork for your organization to best serve members by offering a few basic staff trainings.

Sessions on topics as simple as writing in plain language for varying levels of member comprehension not only help staff accurately communicate about the plan, but they also ensure clinical accuracy so members take appropriate action (e.g., taking the right medication dose).

5. Reach your audience on their terms.

Literacy is all about understanding. Using the aforementioned plain language enhances member understanding by favoring simple terms over medical jargon and helps reach high-risk members.

6. Use best practices to improve your communication strategies.

Our world is digital, so the way you communicate should be, too! Technology enhances the way we share information. Support health-related social needs and reduce administrative burdens for plans and members by providing digital resources that:

• Engage users
• Provide actionable information
• Are available on-the-go

How do health-related social needs impact members?

Feel like you’ve done all the right things, but your members’ health literacy doesn’t seem to be improving? Even if your plan communicates regularly and on members’ terms, coordinates care and resource access, and more, every member walks their own journey. Health-related social needs you don’t know about may be standing in the way.

Enhance member rapport.

Not only has social connection become an important clinical metric for mental health, but it’s also directly linked to health-related social needs. Cultivate member rapport to build trust and uncover hidden needs—such as transportation or food barriers—that may be blocking positive HEDIS outcomes and member adherence.

Pyx Health supports health-related social needs

Without a firm understanding of health risks and interventions, neither your members nor your staff can make meaningful steps forward. Instead of taking a wait and see approach, create a plan to close care gaps that impede members from making the best choices for their well-being.

One key piece of the puzzle? Providing timely interventions.

Pyx Health’s member activation solutions fulfill HEDIS SNS-E 30-day intervention requirements by providing care navigation support for individuals who screen positive for transportation, housing or food insecurity and access to food boxes to address non-clinical barriers. By supplementing clinicians outside of regular provider visits and connecting members to key resources, our team builds the trust necessary to motivate individuals to take positive next steps.

Learn more about how Pyx Health supports members.