Closing gaps in care can positively impact your quality scores and Star ratings. But doing it requires a coordinated effort with providers and members to close the loop. And it starts with getting the right tools that will give you better visibility into the quality measures and gaps where you have the most opportunity, like which providers have the most room for improvement, and most importantly, where to put that information to work.
The Healthx Analytics 360 product is a robust solution that transforms raw data into actionable analytics that enables payers to pinpoint and address problem areas like gaps in care. Having the right data at the right time closes the loop with providers and members so together you can close gaps and achieve quality goals.
Here are four ways Analytics 360 can help close gaps in care.
A Better Way to Monitor Gaps in Care
By combining your members’ claims data, clinical data, demographic data, and quality measures, Analytics 360 lets you see aggregated data on gaps in care and more. Instead of looking up individual members and checking for gaps, Analytics360 provides comprehensive dashboards that deliver actionable data on prevention, performance, cost and utilization, predictive analytics, and population health. You can also identify which primary care physician those members have selected, making it easy to focus on the providers who can have the biggest impact on your quality measures.
Finally, CMS Star ratings and NCQA ratings are market forces that drive the need for powerful analytics tools to help the industry transition from a fee-for-service model to value-based care model. Analytics 360 can quickly and easily identify which measures you’re struggling with, so you can apply your time and energy to the goals that matter most to you.
Give Your Providers Better Visibility
Once you identify the providers you need to reach out to, the Healthx platform makes it easy for your provider network department to follow up. They can update the dashboard in your provider portal to show them a list of patients with a specified gap in care. Instead of asking them to sift through reports, providers are given a simple way to display only the relevant information, so they can then follow up with their patients, your members.
Additionally, you can flag gaps in care, so when your providers look up their patients’ eligibility, it’s easy for them to identify and close gaps.
Recommend Next Steps
If all you do is identify or display a gap, it takes extra work for a provider to determine what next step meets your quality standards, and this extra work can increase the time it takes to close the gap. With Analytics 360, you can provide actionable information by specifying what steps your providers need to take in order to meet your quality standards.
Identify and Close Potential Gaps
Suppose one of your members is diagnosed with Type II Diabetes and their treatment plan includes an eye exam every 12 months. But 8 months pass without any claims for an eye exam. Instead of waiting for the 12th month to go by before flagging this as a gap in care, we help you notify providers right away when your quality standards and a member’s medical history indicate that they need a service. And you can decide how much time you want to pass before informing providers that care is “due soon.”
By encouraging your providers to deliver care before potential gaps, you can significantly reduce their number before they occur.
No One Tool Does It All
But with a robust platform, you can integrate all the necessary tools to facilitate each phase in the process of closing the loop. Mobile engagement tools to help members take the next step. You can give providers a better way to see and understand what’s required of them. And you can give yourself better insight into the quality measures and providers that may be holding your organization back.
Check out our recent eBook, Gaps in Care: Closing the Loop. You’ll see how digital tools can help eliminate gaps in care and how, finally, your organization can maintain the highest standards of care.