HEDIS-Compliant Strategies for SUD Care
Why This Matters Now
Substance use disorder readmissions represent one of the most costly and most preventable challenges facing health plans today. With Plan All-Cause Readmissions (PCR) weighted 3x in CMS Star Ratings, the financial stakes have never been higher.
The Gap Between Crisis and Care
The 7–30 day period following discharge is when SUD members are most vulnerable. Without immediate, accessible support, they cycle back through emergency departments and inpatient stays—driving up costs and dragging down quality scores.
Traditional care models can’t bridge this gap. Phone calls go unanswered. In-person appointments aren’t available fast enough. Members fall through the cracks.
A Measurable Path Forward
The five HEDIS measures highlighted in this infographic aren’t just quality metrics – hey’re a roadmap for breaking the readmission cycle. Each measure targets a critical intervention point where digital tools can automate engagement, close care gaps, and provide 24/7 support.
Health plans using integrated digital recovery support are seeing measurable improvements in both HEDIS performance and readmission rates, protecting Star Ratings while reducing medical costs..
Bottom Line:
Reducing SUD readmissions requires meeting members where they are, when they need support most. Digital tools make that possible at scale.
