Understanding HEDIS: What Those Health Plan Letters Really Mean

Understanding HEDIS: What Those Health Plan Letters Really Mean

If you’ve received a letter from your health plan urging you to schedule a checkup or screening, it may be tied to something called HEDIS. For many seniors, these messages feel confusing or impersonal. So, what is HEDIS—and why does it matter?

What Is HEDIS?

HEDIS stands for Healthcare Effectiveness Data and Information Set. It’s a system used by health plans to measure how well they’re delivering care. These reminders help track things like cancer screenings, diabetes management, medication reviews, and fall prevention safeguards.

Why Seniors Feel Confused

Many older adults misunderstand HEDIS because:

• The messages often lack explanation or context

• It can feel like a checklist—not personalized care

• Some recommendations may not apply to their current health needs

“They told me I needed a bone scan, but I just had one last year,” says Margaret, 72. “It felt like they were checking a box—not checking on me.”

“My next-door neighbor stated to me that it was none of his physician’s business “to know how many beers I drank or how I felt when I wake up in the morning!”

Why It Still Matters

Despite the confusion, HEDIS helps:

• Catch gaps in preventive care

• Improve coordination between providers

• Hold health plans accountable for senior care

New HEDIS measures even focus on older adults—like tracking hospital visits after outpatient surgery for those 65+.

What You Can Do

• Ask questions: Call your provider and ask why a test or visit is recommended

• Keep records: Bring a list of recent screenings to appointments

• Speak up: If something doesn’t feel right, say so—your voice matters

Caregiver Corner: Making Sense of HEDIS for Your Loved One

If you’re caring for a senior, you may receive health plan reminders about screenings or tests. These are often tied to HEDIS—but they don’t always reflect your loved one’s current needs.

Tips for Caregivers:

• Review the message together

• Keep a folder of recent labs and visits

• Call the provider if something seems off

• Ask about exclusions for advanced illness or cognitive decline

“I keep a checklist in OneNote with my mom’s recent care milestones. It helps me push back when something’s redundant.” — Cyndi, caregiver and health writer.

REFERENCES:

1. ADA Standards of Care in Diabetes—2026

This is the ADA’s comprehensive annual guideline covering diagnosis, screening, preventive care, and quality measures used by clinicians and health plans.

Citation:

American Diabetes Association. Standards of Care in Diabetes—2026. Diabetes Care. 2026. Available at: https://professional.diabetes.org/standards-of-care.

2. ADA Press Release — Standards of Care in Diabetes—2026

This press release summarizes major updates, including:

• Technology recommendations

• Obesity pharmacotherapy

• Updated blood pressure goals for older adults

• Screening and monitoring guidance

Citation:

American Diabetes Association. The American Diabetes Association Releases “Standards of Care in Diabetes—2026.” Press release. December 8, 2025.

NCQA HEDIS Overview

National Committee for Quality Assurance. HEDIS Measures and Technical Resources. Available at: https://www.ncqa.org.

CMS Medicare Star Ratings

Centers for Medicare & Medicaid Services. Medicare Star Ratings Technical Notes. Available at: https://www.cms.gov.

By Cyndi Obermaier, RN, BSN, Health Writer

Assessed and Endorsed by the MedReport Medical Review Board