HEDIS and care gap outreach.
Close gaps. Improve health. Earn more stars.
Use intelligent, proactive outreach to engage members who are overdue on important care and screenings—so you can close care gaps, improve outcomes, and strengthen star ratings and quality bonuses.
Explore intelligent outreach
The challenge...
Many members are overdue for important care, screenings, or follow-up visits.
Gaps in care lower HEDIS performance, star ratings, and quality bonus payments.
Manual outreach is time-consuming, inconsistent, and difficult to scale.
The goal is to reach the right members with the right message—at the right time—to close care gaps and improve member health and plan performance.
The objective...
The health plan set out to create proactive care gap outreach that could:
Identify members overdue for HEDIS measures and prioritized care gaps.
Educate members on why the care matters and what’s due.
Help members schedule appointments with in-network providers.
Answer routine questions about screenings, visits, and locations.
Address barriers and connect members to support resources.
Send reminders and encouragement until the gap is closed.
Escalate complex or clinical needs to the right care team.
Track outreach, responses, and closures in real time.
Improve HEDIS measures, star ratings, and quality bonus outcomes.
The Alvaria Intelligence
Platform approach.
AIP ingests claims, eligibility, clinical, and provider data to identify care gaps across HEDIS measures.
AIP prioritizes and personalizes outreach, selects the right channel, and orchestrates conversations across the member journey.
Outcomes are measured, learned, and used to continuously improve gap closure and health outcomes.
Agentic-led engagement for care gap closure.
& leads
or steps in as needed
An agentic agent explains what care is due, why it matters, and how to take the next step. When clinical, behavioral, or social needs arise, the interaction is seamlessly routed to the appropriate human expert.
Agentic begins and leads.
Human supervises or steps in as needed.
Better adherence. Fewer gaps. Lower risk.
Customer value...
- Understands what care is due and why
- Gets help finding in-network options
- Receives reminders and support
- Overcomes barriers to getting care
- Feels protected and supported
Business value...
- Higher HEDIS performance and star ratings
- Quality bonus protection and upside
- Improved member health outcomes
- Lower downstream medical costs
- Stronger member satisfaction and loyalty
Close more care gaps. Improve lives. Earn more stars.
Smarter outreach today leads to healthier people, better outcomes, and stronger plan performance tomorrow.
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