4 Ways Providers Can Help Members Close Gaps in Care

Providers are motivated to help health plans maintain compliance standards as they ensure that their patients, your members, receive the highest quality care. But with a large number of patients for each provider, evolving market standards, and a dozen or more different health plans with specific requirements, identifying and closing gaps in care can be overwhelming and challenging.  

In the past, health plans have used reports to inform providers and their staff about patients’ gaps in care. But asking providers and their staff to refer to difficult to use, static reports does not make the information actionable or achieve the goal of closing gaps in care.

Because members are more willing to take action based on the advice of their provider, it’s essential to set them up for success. Ultimately, their success is your success, and if they fall behind, you do too. Thankfully, you can help close gaps in care by closing the loop between providers, members, and you.

When all of your clinical, demographic, and claims data is integrated within a single platform, you get a comprehensive view of your quality goals and measures, and providers gain visibility into gaps they can close with their patients.

Here’s how Healthx can help.

Aggregate Your Data

When all your data lives on one platform, it’s easy to organize, highlight, and search in practical ways. With Healthx, your provider portal can be equipped with the Quality Measures product, which lets providers see all relevant gaps in care data at once—whether you’re trying to improve quality outcomes, comply with HEDIS measures, increase your CMS star ratings, meet other goals, or all the above.

For example, say you’re not meeting quality goals for members with diabetes, and one provider in particular, has a larger volume of patients who are non-compliant in managing their condition. You can configure alerts and notifications to display in your provider portal, so the first thing the provider will see when logging in is a call to action with a link to your Quality Measures product.

The Quality Measures product shows providers all of their patients with gaps and fulfills the user experience with different filters that make the data interactive and actionable. And they don’t have to look up each patient individually—they can look at everyone who needs an adult BMI assessment, annual eye exam, or annual foot exam.

This drastically simplifies providers’ workflows by providing the data they need, organized in a way they can effectively and efficiently utilize.

Highlight Gaps at the Ideal Times

The best time to talk to members about gaps in care is when they’ve reached out to their provider’s office with questions or an appointment request.

With Healthx, gaps in care are visible through the provider’s patient roster and to office administrators, making it easy to see what other services the member is missing when scheduling appointments or checking them in.

This creates more opportunities for providers to close gaps at the times that are most convenient for your members and when they’re most likely to take action.

Prevent Gaps from Occurring

Gaps in care occur when your members don’t receive the care they need in a specified amount of time. Unfortunately, many plans and providers don’t have tools to proactively flag services their members need until they become gaps. This creates a mad dash to close gaps, and every month that goes by hinders your quality scores.

That’s why we give you and your providers the ability to see and act on potential gaps in care in the same place you monitor current gaps—so you can close them before they ever occur and improve quality outcomes and scores. After all, if those diabetes patients we mentioned above need an eye exam every year why wait 12 months to remind them?

Close Gaps in Care for Good

Closing gaps in care takes a coordinated effort between you, your providers, and your members. And while your members are the ones who have to visit their providers, and it’s your providers who actually deliver the care and services, you can play an integral role in facilitating the entire process by helping to close the loop.

Stay tuned for our new eBook, Closing Gaps in Care for Good, where we’ll share how a single suite of digital tools can help you, your members, and your providers work together.