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How to Improve HEDIS Scores Through Psychographic Segmentation and Omnichannel Communications

Doctor looking over laptop with health documents sitting beside it

Health insurers strive to improve the quality of care and health outcomes for their members, and as an objective standard, the National Committee for Quality Assurance (NACQA) came up with the Healthcare Effectiveness and Data Set (HEDIS). These measures help insurers gauge their offerings in comparison to their competitors and determine where improvements can be made.

  • Care Effectiveness
  • Care Access/Accessibility
  • Care Experience
  • Utilization and Risk-Adjusted Utilization
  • Health Plan Descriptive Information
  • Measures Reported using Electronic Data Systems

While HEDIS measures are a vital part of quality measurement, they also play into the various reasons why plan members choose an insurer. According to 2022 PatientBond market research, these are some of the top reasons why the general population of healthcare consumers joined a new health plan this year:

  • New plan is less expensive than the 2021 plan (20.4%)
  • New plan offers uniquely better benefits and services (19.6%)
  • New plan has better providers/physicians in-network (16.3%)
  • New plan used ads and marketing to convince members it was a better plan (15.6%)

Each reason ties into the fact that members are looking for the best value in their care. Additionally, individuals with specific beliefs, personalities, and motivations, known as psychographics, also show statistically significant distinct differences in health plan capabilities and service emphasis. PatientBond research offers keys to attracting personas for growth and satisfaction. 

Oftentimes, insurers might not communicate offerings well enough either. In the same market research study, PatientBond found that nearly a third of healthcare consumers either skimmed or didn’t read enrollment/benefits of the health insurance plan they joined in 2022.

So, what can insurers do to make sure that members feel supported when improving their health outcomes while improving HEDIS scores? It’s all about communication.

Implement Omnichannel Communications

Every year, members are surveyed about their health insurance and it is a significant factor in determining a HEDIS score. An insurer may have numerous benefits to offer, but if a member doesn’t know much about any of them, it can negatively impact their score.

But thanks to technology, there are numerous ways to connect with healthcare consumers. Through the PatientBond platform, insurers can utilize multi-channel, two-way communications to engage with members about all of their offerings like flu shots, cancer screenings and behavioral/emotional support services. Communications can be personalized and individualized based on a member’s psychographic profile across a large population; plus, communication frequency can be tweaked and optimized to create comprehensive member journeys.

And communication doesn’t have to be limited to internal digital engagement platforms. Members are using social media more and more to research their current health insurance plans. According to PatientBond market research, Facebook (18.6%) and YouTube (18%) are the most popular sites to visit to do this research among the general population, but 8.3% of the general population used TikTok to research their current health plan.

Incorporate Psychographics

For insurers who are unfamiliar with the segmentation model, psychographic segmentation focuses on healthcare consumer motivations and what ideals, values and beliefs draw them to take action on their health. This type of segmentation is much more effective at getting healthcare consumers to take action and results in better health outcomes.

Through communication tools, insurers can incorporate psychographics into their messaging to better appeal to healthcare consumers, from the text used down to the imagery and colors incorporated into the messages. To access these insights, insurers can use the  PatientBond Insights Accelerator™ to identify health issues that resonate with specific healthcare consumers, like healthy eating for Self Achievers, or plan benefits they might want to use, like high cholesterol management for Direction Takers.

One key psychographic segment, Willful Endurers, is especially keen on using social media for health insurance plan research. They’re statistically more likely than any other segment to use Facebook, Twitter, YouTube and even TikTok to research their health plan, and they make up 31% of the healthcare population. In fact, 35% of Willful Endurers in Medicare Advantage plans rely on Facebook and YouTube for information on their health plan. This is a big reason why using psychographic segmentation as a part of the healthcare consumer journey has such an influential impact on growth, retention, and self-management. Once members get a better understanding of what their insurer offers, they will better utilize them to improve health outcomes, which will improve HEDIS scores for insurers. Patients feel better and insurers feel empowered about the way they’re supporting their member’s overall health to provide the best plans possible.

Looking to encourage more behavior change among members? Get an in-depth look at psychographic segmentation in healthcare in our whitepaper.



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