To improve HEDIS measures, hospitals need actionable, trackable strategies tied to patient outcomes. HEDIS, Healthcare Effectiveness Data and Information Set, is a tool developed by the National Committee for Quality Assurance (NCQA) to measure the effectiveness, safety, and timeliness of care. It consists of more than 90 performance indicators across six domains, including chronic condition management, preventive care, and behavioral health..
Higher HEDIS scores translate directly into stronger performance in value-based care programs, contract renewal eligibility with payers, and potential bonuses for providers participating in Medicare Advantage, Medicaid Managed Care, and commercial plans. For hospitals, this also impacts STAR ratings, CMS quality scores, and overall reimbursement levels. Ultimately, improved HEDIS measures directly affect care quality, rankings and revenue.
With tools like Hospital Care patients can easily compare hospitals by type, rating and proximity to their location. Since HEDIS scores help determine many ratings, a low score can make a plan less competitive, leading to lower STAR ratings or utilization of services.
Digital Health interventions such as remote patient monitoring (RPM) have become a strategic asset for hospitals focused on performance-based reimbursement. In the following section, we will discuss these interventions and HEDIS scores.
Digital Health Interventions and Their Measurable Impact on HEDIS
Health systems looking to improve HEDIS measures rely on research showing that digital health interventions and associated telemedicine programs deliver measurable results.
A 2024 case study by SS&C Technologies showed a regional health plan increased performance across 33 HEDIS measures within six months by integrating clinical data sources and automating digital workflows. Two core areas impacted were Hemoglobin A1c and blood pressure control which saw up to 39% and 11% improvements.
SS&C also reported that automating digital data workflows led to less reliance on IT staff, timely care gap closure, and improved audit approval rates. These outcomes translate directly to reduced costs and higher ratings.
How Remote Patient Monitoring Can Improve HEDIS Measures
Remote patient monitoring shifts care from reactive to proactive. It has the potential to improve HEDIS measures by helping hospitals track and manage chronic conditions like diabetes and hypertension in real time. HEDIS scores include specific measures for controlling blood pressure, managing A1c levels, and ensuring medication adherence supported by continuous data and automated alerts.
RPM enables collecting and transmitting health data from patients at home, such as blood pressure, glucose, weight, oxygen saturation. This data helps clinicians identify worsening symptoms, intervene earlier, document care activities and the follow up required for HEDIS scoring. It also supports documentation in EHR systems, ensuring data completeness and compliance.
Lowering Costs and Boosting Reimbursements with Better HEDIS Performance
When hospitals improve HEDIS measures, it does more than boost quality ratings. Improved scores in preventive and chronic care domains can qualify hospitals for shared savings, quality incentive pools, and contract renewals with payer networks. It can also increase revenue for health organizations. According to a Health Affairs study, hospitals with higher HEDIS and STAR ratings receive 5–20% higher bonus payments in Medicare Advantage contracts.
RPM also directly impacts costly, high-visibility metrics like readmissions and emergency visits. A remote monitoring program at UMass Memorial Health–Harrington Hospital cut 30-day heart failure readmissions by 50%, according to AJMC. Using connected devices and real-time data, clinicians intervened early, directly impacting HEDIS metrics tied to readmissions and chronic care management.
Similarly, a 2024 study, a rural cardiology practice followed 40 patients for two years prior to using remote patient monitoring and two years following. After implementing RPM, the clinic saw a 93% drop in heart failure–related ER visits, an 83% reduction in heart failure hospitalizations, and a 73% decrease in unscheduled office visits, with 519% increase in check-up calls.
Implementation Tips for Hospitals Using Remote Patient Monitoring to Improve HEDIS Scores
If your organization is aiming to align RPM to improve HEDIS measures and targets, here’s how to start:
- Map RPM data to specific HEDIS metrics, such as BP readings for Quality ID: #236.
- Prioritize high-risk chronic care patients who frequently miss benchmarks.
- Integrate RPM data into the EHR, ensuring documentation supports digital HEDIS submissions.
- Use alerts and thresholds to close care gaps, prompt follow-ups, and encourage medication adherence.
- Track RPM engagement rates and optimize workflows to improve utilization.
Hospitals should also ensure care team alignment, with clear roles and escalation paths for responding to RPM alerts. Regular audits of documentation and care plans can help validate data for HEDIS submission.
Understanding How to Improve HEDIS Scores
Remote patient monitoring is a strategic tool for hospitals seeking to improve HEDIS scores, reduce unnecessary utilization, and increase revenue under value-based care contracts. While digital data infrastructure is essential, it’s the ability to act on real-time patient data that sets RPM apart. For hospitals navigating tightening margins and increasing performance scrutiny, investing in RPM is both a clinical and financial imperative.
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