by Lydia Pineault

The Health Effectiveness Data and Information Set (HEDIS) is one of the most widely used performance improvement tools. 190 million people are enrolled in a plan that reports a HEDIS score. The HEDIS score, once it is published, can be used to compare different health plans and their effectiveness in multiple areas of healthcare.

The 6 Domains of HEDIS Scores

The HEDIS score is made up of 90 measures that fall under 6 domains.

  1. Effectiveness of Care
  2. Access/Availability of Care
  3. Experience of Care
  4. Utilization and Relative Resource Use
  5. Health Plan Descriptive Information
  6. Measures Collected Using Electronic Clinical Data Systems

Data collected from all 6 domains is then used to create the overall HEDIS score. Health Plans are constantly looking for ways to drive change that positively impacts their score. One of the most influential ways to do so is by implementing a robust telehealth network across contracted providers. Telehealth can directly influence almost every HEDIS domain in a positive way.

Effectiveness of Care

In domain one, Effectiveness of Care, health plans are scored on how effective the care they provide is. Telehealth allows providers to stay connected with their patients after they leave the clinic. Using telehealth to reduce no-shows and increase patient engagement, providers will subsequently increase the effectiveness of their care. When patients have a simple and convenient way to connect to their care team they are much more likely to adhere to their treatment instructions. This adherence will get patients engaged and promote long-term wellness.

Access/Availability of Care

In domain two, Access/Availability of Care, health plans are scored on how accessible their care is to their members. Historically it has been challenging to reach patients that live in rural areas with limited access to providers and clinics. Telehealth can remove that barrier by allowing clinicians to treat patients in a virtual environment. When someone has to drive two hours to see a doctor, the likelihood of that patient showing up is understandably low. But what if that same person could see a doctor in their home through a computer? The likelihood that the patient would now ‘show up’ to that appointment goes up exponentially. Telehealth closes the geographical distance between provider and patient, allowing for more members to access the care they need.

Experience of Care

Domain three, Experience of Care, focuses on the patients’ experience when they seek care. Let’s compare two locations: the first being your living room on your favorite couch and the second being the crowded waiting room at a clinic in a hard plastic chair. Where would you rather be? The first location (at home on your favorite couch) is the clear winner when it comes to comfort, convenience and overall experience. This is the improvement telehealth can bring to the domain three score. When patients can seek care in a convenient manner, in a place they feel comfortable and on their own time, they are much more likely to report a positive experience. In fact, according to research done by NTT Data, over two-thirds of patients said their satisfaction with care was somewhat or significantly increased by using telemedicine.

Utilization and Relative Resource Use

There are two sides to domain four, Utilization and Relative Resource Use.

The first side is: are members using healthcare when they should, and are they using the proper channels for a given situation? Behavioral Health is a great arena to illustrate both sides. Of the 43.4 million adults with a diagnosed behavioral health condition, fewer than half receive treatment. Domain four looks to measure how well plans are increasing this number to get more people the care they need. Individuals with behavioral health conditions are also the highest users of Emergency Departments (ED). Often times, these visits could be prevented with proactive care management and patient education.

The second side to domain four looks at how health plans are controlling these high-cost visits and working to connect patients with appropriate avenues of care. Telehealth addresses both sides of the coin. By making treatment simple for patients to access, they will likely engage in more preventative care rather than waiting for an emergency to occur. Telehealth can be used to keep patients connected to their care team, while also providing education around their condition and the appropriate avenues to go through for care. These factors will lead to a decrease in the occurrence of crisis situations and subsequent ED usage.

Health Plan Descriptive Information

In domain five, Health Plan Descriptive Information, health plans are scored on the descriptive information that they provide. In this domain, digital methods can be employed to deliver the information, however it will not play a large role in score improvement.

Measures Collected Using Electronic Clinical Data Systems

Finally, domain six, Measures Collected Using Electronic Clinical Data Systems, looks at the different screening tools that are being employed the along with the data being collected electronically to assess patients. Examples of these assessment are the PHQ-9 for depression and the unhealthy alcohol screening tool. Telehealth comes into play here as a method for delivery of these assessments. Providers and plans can promote efficiency by delivering assessments through a mobile app or a website. Many telehealth vendors can fully integrate with existing EHRs and HIEs so when patients submit their responses, they would be automatically loaded into their medical file. This saves time on the end of the provider and increases data collection by providing convenience to the patient. It also gives providers a way to target at-risk patients and follow-up with them to address concerns raised.

How to Get Started with Telehealth

Telehealth is a fantastic innovation to the industry. However, it can be hard for organizations to get started with delivering these services. There are many vendors, and not all vendors are created equal. To get more information about choosing a vendor check out our blog post “What to Look for in a Telehealth Provider” or email