Syra Health’s Human-Driven, Digital-First Approach to Improving HEDIS Performance for Leading Health Insurance Provider
When a leading health insurance provider wanted to improve its HEDIS measures, it turned to Syra Health. By combining empathetic, human-first outreach with real-time digital tracking, we helped the insurer close care gaps, engage members more effectively, and exceed quality benchmarks, all while building a foundation for continuous improvement.
What is HEDIS and Why It Matters?
HEDIS, or the Healthcare Effectiveness Data and Information Set, is the gold standard for measuring health plan performance. Developed by the National Committee for Quality Assurance (NCQA), it looks at preventive care, chronic condition management, and access to essential services. Strong HEDIS scores matter because they impact:
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Accreditation and regulatory standing
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Funding, including bonus payments for meeting or exceeding benchmarks
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Public perception, which influences plan selection by consumers and brokers
The Challenge:
The insurer faced three key hurdles:
Closing care gaps faster and more efficiently
Transitioning from seasonal measurement to year-round, digital-first monitoring
Engaging members who faced socioeconomic and logistical barriers, from a lack of transportation to limited healthcare awareness
Syra Health’s Solution: A Hybrid Model for Continuous Quality Improvement
We implemented a hybrid model that combined the best of human interaction and technology. At its center: a dedicated outbound call center with 10 trained agents operating on a centralized digital platform provided by the insurer.
Human Touch
Our agents were trained in empathetic, human-first communications. Instead of relying on generic scripts, they were empowered to have personalized, trust-building conversations. This was critical for engaging hard-to-reach populations.
Technology
The insurer’s platform allowed agents to track member data in real-time, route calls efficiently, and manage performance metrics. This technology-driven approach enabled the shift to a digital-first HEDIS model.
Key Actions:
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Hundreds of personalized calls per agent, per week
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Sharing of insurer-provided gift cards to incentivize appointment completion
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Nearly 200 appointments scheduled weekly
The Outcomes:
Higher Member Engagement
Human-first conversations built trust, while practical supports (like transportation and incentives) removed barriers to care.
Improved HEDIS Scores
More members completed annual wellness visits, immunizations, and other key services, helping the insurer meet or exceed its HEDIS benchmarks.
Operational Efficiency
At the heart of Syra Health’s human-first model are trained agents who understand the role of empathy in healthcare communications. By leading with a human touch, the model builds trust and rapport, critical for driving member action, especially in underserved or hard-to-reach populations. The call center operates from a centralized platform with the technological infrastructure to route calls, track metrics, and manage performance efficiently across geographies, satisfying the HEDIS digital-first requirement.
