Finding the High-Impact Opportunity in HEDIS 2025
While more health plans are reaching 4 and 4.5-star National Committee for Quality Assurance (NCQA) ratings, only five out of 1,019 achieved the coveted five-star level in 2024 (NCQA, 2024). For 2025, as Healthcare Effectiveness Data and Information Set (HEDIS) measures undergo significant updates with more rigorous requirements across preventive care, disease management, and health equity, plans must implement strategic, high-impact interventions—not just incremental improvements—to separate themselves from the competition (NCQA, 2024).
The critical question for health plans is where to focus limited resources for maximum impact. The answer lies in musculoskeletal (MSK) care—a $420+ billion annual cost center that presents a strategic opportunity with outsized returns. Through the industry's only nationwide physician-led MSK care model, Vori Health transforms performance across multiple HEDIS measures, creating substantial quality improvement and cost savings (Evernorth, 2022).
The Physician-Led MSK Approach from Vori Health: Directly Impacting HEDIS Measures
MSK conditions have become a priority for 57% of payers (up from 46% in 2022, per WTW), yet traditional approaches continue to fall short. Fragmented pathways, excessive imaging, unnecessary surgeries, and reactive pain management drive costs higher while undermining HEDIS performance.
Unlike these fractured models, Vori Health integrates comprehensive care through physician-led MSK treatment. As the only nationwide physician-led solution, our specialty doctors provide accurate diagnoses, prescribe appropriate medications, and guide patients to tailored care options while addressing the full spectrum of MSK conditions—including the 40% most complex cases other programs cannot handle. Our approach:
- Ensures clinical excellence: Our physician-led model reduces unnecessary surgeries by up to 90%, delivering up to $3,200 annual savings per member.
- Creates enhanced patient experiences: 48-hour specialist access and coordinated care drives NPS scores above 87, with 91.6% of members reporting clinically significant pain reduction and 82% of members reporting improved physical function.
- Expands health equity: Multidisciplinary teams address social determinants with personalized care and digital accessibility.
- Provides measurement and transparency: Digital integration enables efficient tracking of improvements across quality, costs, and outcomes.
The Force Multiplier Effect
This comprehensive approach creates a compound impact on plan performance by simultaneously improving multiple HEDIS measures, such as:
- Use of Imaging Studies for Low Back Pain (LBP) - Vori reduces unnecessary imaging by providing appropriate clinical assessment first, with less than 3% of members referred for imaging.
- Use of Opioids Measures (HDO, UOP, COU) - Vori Health eliminates new opioids from the equation and reduces chronic usage. Claims analysis shows 42% of patients previously on opioids for at least two months are no longer taking them after Vori care.
- Fall Risk Management (FRM) - Vori's Fall Prevention Program reduces risk through personalized strategies and exercises to improve balance, strength, and mobility.
- Physical Activity in Older Adults (PAO)- As the only physician-led MSK solution, Vori Health uniquely satisfies this doctor-specific measure. Patients receive personalized physician guidance on physical activity, driving exceptional compliance rates and quality measure attainment.
- Depression Screening and Monitoring (DSF-E, DMS-E) - Integrated behavioral health support with validated assessment tools like PHQ-9 as part of Vori's whole-person approach ensures this measure is met for all patients.
- Osteoporosis Management and Screening (OMW, OSW) - Vori physicians order appropriate bone mineral density tests and prescriptions for members with fractures or at risk.
As the only nationwide physician-led solution, Vori's specialty doctors provide accurate diagnoses, prescribe appropriate medications, and guide patients to tailored care options while addressing the full spectrum of MSK conditions—including the 40% most complex cases other programs cannot handle.
Physician-Led MSK Care: A High-Impact Lever for HEDIS, CAHPS & Star Ratings
While physician-led MSK care is a proven driver of clinical HEDIS measures, its impact goes further—improving member experience, boosting CAHPS scores, and strengthening Star Ratings.
By addressing up to ten Star measures simultaneously, including heavily-weighted CAHPS metrics such as "Getting Needed Care" and "Getting Care Quickly", physician-led care delivers up to 4:1 ROI—directly impacting bonus payments, market position, and member retention while providing greater stability in an increasingly competitive Medicare Advantage landscape.
The real-world impact of this approach is clear: Vori's impressive 99% retention rate shows nearly all members choose to keep their same MA plan after experiencing Vori's physician-led MSK care.
The Path Forward
With value-based care models projected to cover 90 million lives by 2027, health plans must act now to align MSK strategies with evolving HEDIS requirements (McKinsey, 2024).
Vori Health's comprehensive, physician-led approach offers a proven path to quality improvement with up to 4:1 ROI, helping health plans achieve better HEDIS performance, higher Star Ratings, and superior MSK outcomes for member populations.
Learn how Vori Health can transform your MSK strategy today.
REFERENCES
- NCQA, 2024: NCQA Unveils 2024 Health Plan Ratings. National Committee for Quality Assurance.
- NCQA, 2024: HEDIS MY 2025: What’s New, What’s Changed, What’s Retired. National Committee for Quality Assurance.
- Evernorth, 2022: Patel U. Americans in Motion: The Total Cost of Managing Musculoskeletal Conditions. Evernorth Research Institute.
- WTW, 2023: 2024 Global Medical Trends Survey. WTW.
- McKinsey, 2024: Patel N, Singhal S. What to expect in US healthcare in 2024 and beyond. McKinsey & Company.
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