Healthcare Effectiveness Data and Information Set (HEDIS)

SCCP supports the work of health plans to improve their HEDIS scores by closing member care gaps for the following HEDIS measures:

Prevention and Screening

      • Breast Cancer Screening (BCS)
      • Cervical Cancer Screening (CCS)
      • Colorectal Cancer Screening (COL)

Behavioral Health

      • Follow-Up After Hospitalization (FUH)
      • Follow-Up After Emergency Department Visit for Mental Health (FUM)
      • Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)

Medication Management and Care Coordination

      • Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)


      • Adults’ Access to Preventive/Ambulatory Health Services (AAP)
      • Annual Dental Visit (ADV)
      • Prenatal and Postpartum Care (PPC)


      • Child and Adolescent Well-Care Visits (W30, WCV)

We employ the following strategies to close HEDIS care gaps:

    • Reducing engagement fragmentation by creating a single touch point for HEDIS compliance outreach.
    • Providing coordinated HEDIS Compliance Support to members:
        • Scheduling HEDIS gap closure appointments (wellness visits, lab work, health screenings, etc.).
        • Appointment reminder calls.
        • Post appointment follow-up to ensure compliance.
        • Addressing barriers to HEDIS compliance (i.e., transportation).
        • Addressing member health literacy through education.
        • Addressing exclusions.
        • Making social service referral where necessary to support gap closure.
    • Encouraging at-home testing where available.
    • Using a multichannel approach to member engagement (phones, texting).
    • Offering clinical support (NPs under the supervision of a Medical Director) to close Gaps:
        • Ordering lab tests where needed.
        • Clinical engagement (wellness exams and other examinations) via onsite, telehealth, or home visits.
    • Sharing reports through a robust data integration platform.