Creating a Care Gap Closure Program

The rates for closing gaps in care are some of the most widely used, quantitative metrics to measure quality, allocate incentives, and control costs. Unfortunately, health plans face numerous obstacles closing gaps in care, from social determinants of health to inconsistent (or non-existent) care coordination, and don’t always have a care gap closure program in place.

Thanks to digital care coordination, however, health plans can be well equipped to jump these hurdles. With the right combination of technologies, health plans can easily overcome these challenges and fast track the path to closing those gaps.

So, what makes a good care gap closure program? The following steps have proven successful for our health plan customers looking to close gaps in care:

Call Center Scheduling
Many health plans are still grappling with the difficulty of three-way scheduling calls between themselves, members, and providers. Calls are lengthy and cumbersome, with agents digging through binders of information and schedules to determine the right provider or putting the member on hold while they speak with provider staff. Not only are agents unsure if they are scheduling members with the closest available appointment slot, but members are much more likely to drop out of the scheduling process entirely when faced with this experience.

With MyHealthDirect, member engagement call centers can eliminate the three-way call entirely. Guided search helps narrow down the best fit provider for each member and real-time views of provider calendars allow for immediate, on-the-spot appointment scheduling right in the platform without having to phone the provider’s office.

Real Results: A study conducted by one of our health plan customers demonstrated a 56% increase in care gaps closed when call center agents booked appointments through MyHealthDirect.

Automated Outreach
Enabling call center agents to book appointments more easily is a great way to close more gaps in care. But what it you could close gaps without a single call center agent? With our digital care coordination platform, you can. Now health plans have the ability to automate outreach via interactive voice response (IVR) or text message (SMS) to enable members to schedule appointments on-the-spot, either through a link in the text or during the IVR call.

outreach

The automation improves the member experience by offering convenient access to care while also enabling health plans to close more gaps in care – all without a single call center agent.

Real Results: In another study conducted by one of our health plan customers, they saw a 32% increase in care gaps closed for members reached by MyHealthDirect’s automated outreach solution.

The Ultimate Combination for Closing Gaps in Care
Used alone, automated outreach and call center scheduling are both effective for closing gaps in care. The beauty of the solution is that they both utilize the same underlying digital care coordination platform. That means, when you have one in place, it’s easy to activate the other. In fact, when used together, health plans can close even more gaps in care and further improve efficiency.

Health plans will usually have a list of individuals to follow up with on a regular (bi-weekly or monthly) basis to book whatever care service is needed to close the gap in care. Those members can first be reached via IVR or text, prompting the individual to schedule an appointment. In this way, the “low-hanging fruit” can self-schedule and essentially self-close their gap in care, without a single live agent phone call. For those members that didn’t schedule in the automated outreach campaign, call center agents can reach out to them directly to book the necessary appointment. There are certain people who need a real person interaction to make their appointment, and this solution helps agents focus on those who need it most.

To learn more, download our guide on digital care coordination for health plans.

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