HEDIS Gaps in the Second Half: A Playbook for Health Plans That Need to Catch Up Before Year-End

We’re halfway through the year and at the unofficial reckoning point for health plan quality teams. The HEDIS measurement year is running. Mid-year reviews are underway. And for many plans, the gap between where performance sits and where it needs to be to protect Star Ratings is becoming uncomfortably clear.

The good news, HEDIS performance is still very much in play. The measures health plans can meaningfully move in the second half of the year — colorectal cancer screening, kidney health evaluation, HbA1c testing for members with diabetes, and more — are among the most actionable, highest-impact measures in the HEDIS set. But only for plans that have the infrastructure to activate members quickly and at scale.

This is what H2 gap closure actually looks like, and what separates plans that improve from plans that don't.

Why H2 Gap Closure Is Different

Health plan quality teams spend a lot of Q1 and Q2 identifying gaps and preparing outreach. The H2 is where the rubber meets the road. Members who haven't completed a screening by mid-year need a reason to act now. And that reason has to clear the barriers that already stopped them from acting earlier in the year.

Those barriers are significant. According to NCQA, HEDIS is used by more than 90% of the nation's health plans; yet, national averages for key measures remain far below optimal. Roughly 1 in 3 Medicare beneficiaries doesn't know what preventive services are covered under their plan, meaning many members who qualify for a screening have no idea it's available to them at no cost. And even among members who are aware, access is often the limiting factor: more than 100 million Americans face barriers to accessing primary care.

Clinic-based outreach — letters asking members to schedule an appointment — works for the members who were going to act anyway. It rarely converts the hard-to-reach.

The Measures Worth Prioritizing Right Now

Not all HEDIS measures are equally actionable in H2. Some require long-term behavioral change or multi-year tracking. Others can be closed with a single completed test. Here's where health plans typically find the most opportunity:

Colorectal Cancer Screening (COL). The FIT test is the most accessible form of colorectal cancer screening — a self-collection stool sample completed at home and mailed to a CLIA-certified lab. It counts for HEDIS. It's high-volume and relatively straightforward to deploy. And for members who've avoided colonoscopy scheduling, it removes the single biggest barrier. 

See our breakdown of at-home FIT testing for HEDIS in Colon Cancer Gap Closure: The Role of FIT Testing.

Kidney Health Evaluation for Patients with Diabetes (KED). KED requires two tests: a urine albumin-to-creatinine ratio (uACR) and eGFR. Both can be completed through at-home collection — a urine sample and a blood spot card. The KED measure saw an average improvement of more than 5% across all product lines in NCQA's 2025 Health Plan Ratings, signaling that plans are finding traction here. But plenty of runway remains, particularly in Medicare Advantage populations where diabetes prevalence is high and clinic visit rates are low. 

Learn more about how to close gaps in CKD screening and improve the KED measure.

HbA1c Screening for Patients with Diabetes (GSD). Glycated hemoglobin testing is another measure that maps well to at-home blood spot collection. Members with diabetes who haven't had a recent A1c test are a defined, targetable cohort — and a dried blood spot card sent to the right lab produces a clinically valid result. 

See Meet HEDIS Requirements for Diabetes with Remote Care for more detail.

Cervical Cancer Screening (CCS). The CCS measure covers HPV testing and Pap smears for female members aged 21–64, with testing intervals that vary by age and prior results. For members who delay or forgo routine gynecological visits — due to scheduling friction, transportation barriers, or discomfort with in-person exams — at-home self-collection HPV testing is a meaningful alternative pathway. Ash supports the CCS measure through at-home HPV collection, removing the clinic visit as the only route to closure. For female members who've been in your gap list for multiple measurement years, this is often the approach that finally converts.

 Learn more about Ash's cancer screening gap closure programs.

Chlamydia Screening (CHL). For younger female members, chlamydia screening is a HEDIS measure that is routinely undercompleted — and it's one where at-home urine self-collection removes significant stigma and access barriers. ‍

Read more in Closing Gaps in Care With At-Home Chlamydia Screening.

What Actually Moves Members in H2

The behavioral challenge in H2 gap closure is inertia. Members who haven't acted in the first six months of the year have already opted out of the traditional outreach approach. Moving them requires a different strategy — one built around how people actually make decisions under competing demands, not how health plans wish they would.

Here's what the evidence and practice show works:

• Send a kit, not a letter. Asking a member to schedule a lab appointment puts the burden on them. Putting a kit in their mailbox shifts the activation model entirely. The action required is smaller, the timeline is self-directed, and the friction points (transportation, scheduling, wait times) are gone.
• Lead with what they'll lose, not what they'll gain. Loss aversion is one of the most robust findings in behavioral economics — people are roughly twice as motivated to avoid losing something as they are to acquire an equivalent gain. "Your covered cervical cancer screening expires December 31" outperforms "Take advantage of your free preventive benefit" because the first framing makes inaction feel costly. Communications that frame the unused benefit as something being left on the table consistently outperform gain-framed messaging.
• Run multi-channel outreach (and sequence it deliberately). Plans using single-channel outreach see significantly lower completion than those running coordinated multi-touch campaigns. Members who receive Ash's multi-channel outreach complete testing 2.4x more often than with single-channel methods. Each touchpoint is a new opportunity to catch a member in a moment when they're ready to act.
• Make the experience feel like your plan's, not a vendor's. A white-labeled kit that arrives with the health plan's name on it signals that this is a member benefit, not an unsolicited outreach. Members trust communications that come from a brand they've already opted into. A generic third-party logo on the envelope is a reason to throw it away.
• Use bilingual communications. English-only outreach leaves a significant portion of the member population unreached. Spanish-language communications across IVR, email, SMS, and kit instructions are standard in well-designed programs — not an add-on.
• Plan for the replacement cycle. Not every kit that ships gets returned. Build a replacement workflow into your program design before the window closes, targeting members who received a kit but haven’t made it across the finish line.

The HEDIS Gap Closure Timeline You Should Be Running Now

For most HEDIS measures, data collection closes at the end of the calendar year. That means health plans have approximately six months of runway from mid-year. Here's how that window typically breaks down:

Now through August: Identify the gap population using eligibility data. Segment by measure, age cohort, and outreach history. Prioritize members with zero prior-year completions — these are the hardest gaps to close, but also the most impactful.

August through Mid-October: Deploy kits and run omni-channel outreach. Monitor member activity and reach out via appropriate channels at the right time. For members with returned kits, run a replacement cycle before the window closes.

Mid-October through December: Run the tail. Members who received a kit and didn't return it get a final reminder push. For members who completed testing, begin routing results to PCPs and care management teams. Documented results need to make it into medical records before the data submission window.

Starting this process now makes a measurable difference in how many gaps get closed. The members you reached out to in H1 may still come in — they just need more time and more touchpoints.

Building H2 Gap Closure Infrastructure

For plans that don't yet have an at-home testing program in place, H2 is still enough runway to launch a meaningful program — if the partnership and logistics are established now. The DBS Testing for Health Plans post outlines how dried blood spot collection supports multiple HEDIS measures through a single kit design, which simplifies logistics for plans managing multiple gap populations simultaneously.

Plans that do have programs in place should be asking right now: where is the performance data pointing? Which measures are tracking below target? Which member segments have low kit return rates? The mid-year QBR is the time to adjust — not Q4, when there's no time left to course-correct.

Gap closure at scale is always a second-half challenge. Plans that treat the measurement year as a full-year sprint (not a Q1 build and Q4 scramble) consistently outperform.

Ready to build or accelerate your H2 gap closure program? Contact Ash to learn how we help health plans close HEDIS gaps through at-home testing across 100+ biomarkers in all 50 states.

‍