Risk Adjustment

How to Close Care Gaps For 2019

With several months left to close care gaps for 2019 and improve HEDIS quality measure performance and boost STAR ratings, most health plans are actively analyzing their data, conducting member and provider outreach and running targeted campaigns.

When it comes to creating a care gap closure program however, there’s no one-size-fits-all approach. A wide range of strategies and tactics can help but by looking at your data, using predictive analytics and creating personalized campaigns, it is possible to close care gaps before 2020.

Here are some ideas to think about.

Start With Provider Outreach

Your care gap strategy should start with provider outreach.

It’s important to give providers as much information as possible about your members, their past visits and lab results so they can identify care gaps and other diagnoses.

When providers have a 360-degree view of their patients before the visit, it’s much easier to close care gaps.

Segment Your Data and Find Solutions

When analyzing your data, it’s important to segment out members for whom closing care gaps has been challenging.

Looking at member behaviors the previous year and whether or not you were able to close care gaps can inform your strategy this year.

For example, setting up a 3-way call to schedule doctors’ visits, sending SMS or voice reminders, and conducting post-visit follow up calls to verify members kept their appointments are all great ways to close care gaps.

If getting to the provider’s office is an obstacle, you can help to arrange transportation, which is a low-cost way to keep members engaged.

Looking at geocodes to determine areas where transportation is limited, can be a proactive way of identifying members who need help getting to their physicians. For these members, a home visit, although pricey, is very effective.

Create Personalized Member Experiences

Finding ways to provide personalized member experiences and better engage members in their care can help close care gaps. Take United Healthcare in Nevada who incentivized a group of their members with a “Mani for Mammography,” program. Once members completed their mammograms, they received a gift card for a manicure at their preferred nail salon.

Not only did the program prove to be an effective way to close care gaps, but it helped to identify members who needed additional care. Of the 90 percent of women who had a mammogram, 7 were diagnosed with stage 1 breast cancer and 2 with advanced stage breast cancer.

Sending members gift cards for mammograms, eye exams and other preventative health screenings can also be an easy, low-cost and effective way to close care gaps.

Add a Human Touch

It’s important to identify the barriers that may prevent members from getting the care they need.

According to a November 2017 report by the American Hospital Association’s Health Research & Educational Trust (HRET), social and economic factors such as nutrition, housing, education and transportation account for 40 percent of a person’s health.

Members with type-2 diabetes for example, may feel embarrassed because they haven’t been able to get their blood glucose under control. Enrolling them in a diabetes education program or having a nutritionist reach out however, can be the perfect intervention at the right time.

Remember, you’re not only closing care gaps, you’re addressing risk adjustment, population health and disease management too.

Keep Outreach Concise

When reaching out to members, it’s important that your outreach coordinators are concise and straightforward.

For example, when talking about scheduling an appointment for a colonoscopy, explain that it’s recommended for people over 50 instead of running through the benefits of closing the care gap.

There are a variety of campaigns you can try to close care gaps in 2019, but it’s important to look at last year’s success and make sure your goals can be measured. Once you understand your members’ barriers and what prevented you from closing care gaps, you can easily tweak your strategy and create solutions that work.

To learn more about our HEDIS and STAR analytics and our flexible solutions for closing care gaps, contact us today.


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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider