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The Ultimate Checklist for Health Plans to Close Care Gaps


The Ultimate Checklist for Health Plans to Close Care Gaps

February 27, 2024 | 5-minute read

Ultimate Checklist for Health Plans

A study by Health Affairs revealed that fragmented member data could result in up to $78.2 billion in wasteful spending on over-treatments and avoidable readmissions annually in the U.S. healthcare system. Addressing this challenge head-on, Health Chain has been collaborating with Payers to expedite the closure of care gaps, while simultaneously reducing provider abrasion and enhancing departmental collaboration. The goal is to foster a more member-centric approach to closing gaps in care. In this webinar, our speakers present a cheat sheet for Payers to embrace a data-driven strategy for care gap closure.

Real-Time Processing with Timely Data Extracts:

Efficiency is key in closing care gaps. Real-time data processing and analytics allow Health Plans to act swiftly on emerging care gaps, ensuring timely interventions. With the Centaur Data Platform, Health Plans can achieve real-time processing by ingesting and normalizing all relevant FHIR and non-FHIR data collected across all Member touchpoints – from sources including EMRs, enterprise data warehouses, health information exchanges, CRMs, claims DBs, Pharmacy, CM/UM tools, Labs, HEDIS data, ADT sources and more - ensuring that the information is readily available in one longitudinal member record for consumption and timely interventions.

More Frequent Monitoring of Quality Measures:

Primary care providers (PCPs) spend nearly six hours each day interacting with the EHR but burdensome documentation processes in the EHR make it difficult to improve performance and close care gaps. In the event a member doesn’t receive certain preventive services or screenings—based on age, gender, or health status—a care gap is created. As care gaps accumulate within a member population, the desired level of care quality declines, which is reflected in the HEDIS score. More frequent monitoring of HEDIS Measures is vital in improving quality of care and CMS Star Ratings. Health Chain’s Quality Analytics dashboard allows Health Plans to monitor key performance indicators and quality measure targets in real-time to ensure proactive identification and communication of specific members within population groups that need care gaps validated and addressed.

Custom Environments and Workflows for Payer Processes:

With data, flexibility is key. Payers can use data to isolate, prioritize, and solve members’ healthcare challenges. Today, Payers need to ensure that their data platforms have embedded workflows that can activate downstream applications, analytics, access, AI use cases and real-time orchestration of the enterprise ecosystem. Centaur Data Platform supports the ingestion, mapping, cleansing and normalization of all FHIR and non-FHIR data to ensure the flexibility of data to be used in different formats across enterprise workflows. Shaping a canonical FHIR data repository can help analyze member data more effectively to identify trends, predict health risks, and tailor interventions to close care gaps.

Increases Visibility and Collaboration Across Payer-Provider Ecosystem:

Visibility and collaboration are at the core of successful care gap closure. The democratization of Member data across the organization fosters collaboration and promotes a cohesive approach to care gap closures. Provider organizations spend $40,000 per physician per year on reporting on quality measures, according to a report. The biggest challenge is that physicians are unable to access complete and up-to-date information at point of care. Forward-looking Payers investing in health data management platforms eliminate the issue of disjointed data sources for not only the health plan, but also providers through bi-directional data exchange with EMRs, eliminating the need for adhoc chart chasing, which reduces provider abrasion and improves the overall quality of care. poor delivery of care.


As the webinar "The Ultimate Checklist for Health Plans to Close Care Gaps" concluded, Health Chain ensures Quality Improvement professionals are equipped with a comprehensive guide to data-driven care gap closure. The checklist, covering real-time quality data processing, claims data inclusion, more frequent quality performance monitoring, configurability and enhanced visibility, empowers Health Plans to bridge care gaps efficiently, leveraging the capabilities of the Centaur Data Platform, HC Quality Analytics, and HC SQLAI. Schedule a personalized demo.

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