Gaps in care not only negatively affect patients’ health but can be detrimental to quality scores.
A gap in care refers to situations where a patient does not receive a necessary or recommended best-practice medical treatment, screening, or intervention. It can also include situations when there is a breakdown in the continuity and quality of care provided by healthcare providers.
Identifying and addressing gaps in care is an important aspect of improving healthcare outcomes, ensuring your patients receive the best possible care, and qualifying for payment bonuses.
Why Should You Care About Closing Gaps In Care?
Quality measures have become increasingly important as Medicare and other payers shift towards value-based payment models.
The Medicare Quality Payment Program/Merit-Based Incentive Payment System (MIPS), Healthcare Effectiveness Data and Information Set (HEDIS), and the Medicare Advantage Star Rating system are just a few programs prioritizing closing gaps in care.
These programs incentivize healthcare providers to offer timely and effective care to their patients. To improve quality scores and qualify for bonus payments, healthcare providers must be able to show strong performance in identifying and addressing gaps in care.
Addressing gaps in care refers to both general preventive care strategies, such as receiving flu shots and attending annual wellness visits, as well as targeted prevention for chronic conditions, such as A1C tests or yearly eye exams for diabetics.
By not addressing gaps in care, your organization is not only missing the opportunity to improve your patient outcomes but also your revenue.
That’s why we include Gap Closer™ technology within our Medicare chronic care management platform. Gap Closer™ helps identify, track, and close gaps in care, resulting in a 25% increase in gap closure vs. the MIPS national average.
How Does Gap Closer™ Work?
First, Gap Closer™ helps care managers prioritize which gaps in care to address on a given call or intervention by providing a list of their gaps in care, as seen below. Then, our RN care managers use clinically appropriate best practices to get patients the care they need.
Gap Closer™ includes pre-filled, condition-specific content focused on the gaps in care most requested by CircleLink’s provider customers. These include diabetic eye exams, annual wellness visits, vaccinations, and cancer screenings, among others.
This care manager-facing perspective helps organizations keep track of difficult-to-meet quality measures and adjust processes to close gaps in care.
Gap Closer™ also features customized, intelligent input forms for each care gap (i.e., below Pneumonia vaccine type and dates).
These forms help streamline data collection, minimize errors, and enhance the efficiency of care managers. They also prompt care managers to take action on the identified gaps in care, whether by scheduling appointments or devising alternative, clinically appropriate plans to close them.
Gap Closer™ also includes population-level data reports, like below, that allow organizations to visualize their gaps in care across all of their patients and track organization-wide progress toward meeting quality measure goals.
Exportable report: One tab per gap in care
The population-level data reports generated by Gap Closer™ can assist in identifying patients or groups who may still have gaps in care, despite efforts to close the high-priority gaps. By leveraging this information, practices and health systems can evaluate the underlying reasons for persistent gaps in care and pinpoint potential solutions and areas for improvement.