Health Plans Need These 5 Critical Elements to Close Care Gaps Faster

Innovation in the healthcare industry takes time, but that doesn’t mean health plans should settle for the status quo when it comes to technology. And while payers research new and exciting ways to serve their population, most of the tools themselves are severely lacking in updated functionality worthy of the 21^st century.

One of these tools is a care gaps analytics solution. A well-developed care gaps tool should not only help you close care gaps faster, it should also aid in reducing provider and member abrasion, reserving resources, and help make everyone’s job easier across the organization. But to achieve all of that, there are five critical components a payer needs to consider before investing in a care gap analytics tool for the best return on investment.

1. Daily Processing with Up-to-Date Data Extracts

One of the biggest issues in the industry right now is the circulation of old data.  Most health plans have a 45-day claim lag when it comes to receiving the information they need to close care gaps and a lot of care gaps tools in the market right now only send reports on a monthly basis. This can be a huge problem not only for the health plan but for the providers, as well. Receiving data that late means there's a higher probability that the data has changed or the gaps have closed naturally since then.  So providers are getting information about care gaps that have potentially already been closed or are no longer relevant.

Having daily processing cuts down on provider abrasion since payers are able to give providers the most up-to-date information on current care gaps that they need to focus on.

2. Includes Pre-Adjudicated Claims Data

Pre-adjudicated claims data is claims data in its truest and rawest form, so there's a higher level of accuracy and comprehensiveness. And since it's not going through the adjudication process (which could take longer than 30 days), there's less lag time in which the health plans can get their hands on the information. And which it comes to an advanced care gap tool, the speed of the data is everything.

3. All Measures Are Sourced and Endorsed

You want to be monitoring what matters, so having accurate and complete measure sets is a big non-negotiable when it comes to filling care gaps. 

When you have sourced and endorsed measure sets, you know that they're following clinical practiced guidelines and typically the benefits that are offered to members match up to sourced and endorsed measures. So not only are you closing gaps at the right time, the health plan can get accurate comparisons against national standards and benchmarks, which is helpful when HEDIS season rolls around. Less member abrasion makes your team's job a lot easier.

4. Configurable Use within Different Environments and Workflows

This is probably one of the more important elements that you need in a care gaps solution. Being able to feed accurate care gap insights into any workflow makes it easier to focus on those gaps year-round and easier for the whole organization to help close those gaps faster. With this kind of flexibility,  health plans can start to break down departmental silos and get multi-departmental support in their initiatives to close care gaps faster without using up more resources. It's a win-win-win! 

5. Increases Visibility and Collaboration Across Your Organization

This is a natural by-product of everything that was mentioned above. When you're getting daily insights with clean, relevant data, you're able to empower your providers to help your organization close current care gaps. This will ultimately lead to better collaboration within your organization and outside stakeholders, along with more visibility on what your team needs to focus on to advance your care gap initiatives. 

So before you invest in a solution that will help you with your quality and care initiatives, make sure it checks the boxes on these five elements so you can get the most bang for your buck. Vital Data Technology's Affinitē Insights solution leverages sourced and endorsed measures to provide health plans with daily and near real-time visibility into open care gaps. With this tool, health plans can close care gaps faster while reducing provider abrasion and increasing departmental collaboration, which promotes a more member-centric approach to closing gaps in care.