Checklists & Guides

Guide - Closing HEDIS Care Gaps

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Page 2 of 3 Step 1 Identify the Care Gaps Knowing which members have gaps in their care is an important first step. To target individuals with care gaps, first identify those health plan members who are not meeting the standards for the treatment of specific conditions or who are identified as not receiving important preventive screenings. SPH can help identify those members through our Population Care™ registry or our Condition Intelligence Analytics™. Once these members have been identified, it is critical that health plans take action to bring these members into compliance. Step 2 Focus on Measures that Affect Large Numbers of Members and High-Volume Provider Groups SPH recommends that plans focus on gaps that affect many members, such as mammograms, colorectal screenings, diabetes care, heart disease, and flu shots. SPH also recommends sending co- branded messages to provider groups with large numbers of members and/or with significant numbers of members identified as having gaps in care. This informs providers of the program and establishes office preferences for appointment scheduling. Step 3 Multi-modal Outreach to Activate Patients SPH recommends connecting with members through omnichannel outreach programs, including mail, email, text, live call, and IVR. Communications include: • Reminding members that they are missing a screening or follow-up that is important to their health and well-being • Setting up an appointment with their doctor while they are on the phone • Performing medication adherence outreach • Providing education to members Step 4 Close the Loop SPH recommends that plans make sure the care gaps are actually closed, by scheduling reminder calls to remind members about upcoming appointments, as well as follow-up calls to ensure that members went to the appointment or reschedule if not. Engaging with your members is the first step on a journey that leads to education, activation, and better health. Let us help you on your journey to close care gaps by creating a custom engagement program for your membership. Navigate Members Toward Better Health • Personalized outreach from highly skilled, bilingual call center staff encourages appropriate screenings and preventive care • Closing gaps in HEDIS compliance increases Star Ratings and revenue

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