HEDIS and Stars, for health plans
Close care gaps with member messages people act on.
HealthLiteracyCopilot turns a HEDIS or Part D adherence measure into a plain-language member journey: letters, texts and call scripts, planned against the measure's outreach window and tailored to your members' barriers. The library also tracks CAHPS and HOS.
Your reviewers approve every piece. Then you export one package your print, text-message and CRM vendors can load.
How it works
From measure to vendor-ready package
- MeasurePick a HEDIS or Part D adherence measure from the library.
- PlaybookOpen the journey generator prefilled from the measure's playbook, and add personas to tailor it.
- JourneyGet a staged letter, text and call journey, planned against the outreach window.
- ReviewRun a persona pre-flight, then your reviewers approve every piece.
- PackageExport a HEDIS package in your vendors' file layouts.
Measure library and Command Center
Start from the measure, not a blank page
Look up each HEDIS, Part D, CAHPS and HOS measure the way your outreach team needs it: who counts, what closes the gap, the exclusions to respect in messaging, the barriers that keep members from acting, and related measures.
The HEDIS Command Center puts your measures on one screen. It shows the days left in the measurement period with a recommended outreach buffer, adds up the closures you still need to reach the next star, and ranks your measures as tiles. The measurement-year planner warns you when a journey launches too late or outreach piles up in the fourth quarter.
Each measure card is a planning summary. The licensed NCQA or PQA specification still decides who is in the measure.
Generate from playbook
From a measure to a staged member journey
Open a HEDIS or Part D adherence measure and choose Generate from playbook. The journey generator opens with the measure's playbook filled in: audience, timing, channels and the journey outline. Add personas to tailor the messages, and HealthLiteracyCopilot drafts a staged journey across direct mail, text messages and phone calls. The journey is planned against the measure's last outreach day.
Messages are tailored to the confirmed barriers of the personas you choose. Related screenings can share one journey: a preventive screening bundle covers colorectal and breast cancer screening in one set of touches, instead of two campaigns.
Playbooks cover cancer screenings, well-child and prenatal care, diabetes and statin care, immunizations and Part D medication adherence.
Guardrails
Built into every journey
Texts that fit one message
Every text fits a single segment and includes an opt-out instruction. A text that breaks the rule stays out of the package, even after approval.
"Already done?"
For screenings and other care-based measures, members who got the care somewhere else can tell you. The package labels it for your supplemental-data workflow.
Contact limits across journeys
Set plan-wide limits: contacts per 7 and 30 days, quiet hours in the member's local time, and which measures come first. Defaults start at 3 a week, 6 a month, and quiet hours from 9 pm to 8 am.
A compliance gate before export
Only approved pieces that haven't changed since approval go into the package. Approving past a check that warns or fails takes a written exception note, and the checks that block, like the text rule, allow no exception.
Before launch
Test the journey before members see it
Persona pre-flight
Simulated members built from your personas read the journey and score it on five dimensions. The scores are simulated. They are not closure rates.
- Why it matters
- What to do and by when
- Numbers
- Teach-back
- Trust
Pilot experiment
Design a randomized pilot with two to four arms, sized for 80% power, with an intention-to-treat readout. It works from counts, never member rows.
Journey Artifacts and the HEDIS package
Approve once. Hand your vendors a ready package.
Your reviewers read and approve every letter, text and call script in one place. Then Export HEDIS package builds one ZIP: texts as CSV, letters as Word and PDF, call scripts as Word, plus files laid out for your CRM, print and text-message vendors.
Save your vendors' column layouts once, and every package uses them. A manifest lists every file, and a SHA-256 hash for each one shows nothing changed after export.
Targets
Plan targets and a Stars what-if
Enter your numerator, your denominator and the star thresholds you plan against, with where they come from. Slide the lift you expect from outreach to see the estimated rate and star level. It is a planning estimate, not a CMS calculation.
For health plans
Why quality and Stars teams use it
Launch campaigns faster
Go from a measure to a reviewed, multi-channel journey in one workspace, instead of briefing writers measure by measure.
Messages members understand
Plain-language letters, texts and call scripts, tailored to the barriers your personas confirm.
Respect member fatigue
Set contact limits, quiet hours and measure priority once. Overlapping journeys are flagged, your sender applies the limits, and bundles combine related screenings.
Plan inside the measurement year
The deadline banner, outreach buffer and planner show what is left of the window that counts and flag late launches.
An audit-ready trail
Approvals, the compliance gate, a manifest and file hashes show what was approved and that it didn't change.
Fewer vendor round-trips
Files arrive in your vendors' own layouts, ready to load.
Each gap you close counts toward your HEDIS rates. If the measure is one of the Medicare Star Ratings measures, it counts there too, and Star Ratings shape Medicare Advantage quality bonus payments. We don't promise a rate or a star. A pilot on your own members shows what changed.
Questions
Does HealthLiteracyCopilot calculate HEDIS rates or Star Ratings?
No. It plans and drafts the member communications behind a measure. Official rates come from your certified HEDIS engine and from CMS. The Stars what-if is a planning estimate.
Which measures does it cover?
The measure library covers HEDIS, Part D, CAHPS and HOS measures. Playbooks cover cancer screenings, well-child and prenatal care, diabetes and statin care, immunizations and Part D medication adherence.
Do you need member data?
No. Journeys are built from the measure and your personas. Pilot designs work from counts, and small cells are withheld.
Does it send the letters and texts?
No. You export a HEDIS package, and your print, text-message and CRM vendors send. Contact limits and quiet hours are set once for the plan, overlapping journeys are flagged, and the package tells your vendors to apply them.
Who approves the content?
Your reviewers approve every letter, text and call script. Only approved pieces that haven't changed since approval go into the package.
Start with the gap-closure letters you already send.
The HEDIS Gap-Closure Letter Kit has a one-ask template and before-and-after examples. Upload one Word document or PDF, up to 5 pages. It is scored against N-PLAT and rewritten in plain language, with the reason for each change. Text only: we read the words and nothing else. Pictures, logos, charts and shapes are removed and never read, and so are a Word file’s text boxes. PDF pages that are scanned, or that have text on a picture, are refused.
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